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Resumen Introduccion A 30 de abril de 2020, se habian notificado 203.715 infecciones SARS-CoV-2 en Espana, 54.486 en Madrid, y el 21,4% eran trabajadores de la salud. El objetivo del estudio es determinar la prevalencia serologica de infeccion SARS-CoV-2 en trabajadores de un hospital monografico pediatrico. Metodo Del 13 al 30 de abril, 1.523 trabajadores fueron convocados a realizar un test serologico (All Test®) frente a SARS-CoV-2 y respondieron un cuestionario con informacion demografica, clinico-epidemiologica y de exposicion a COVID-19. Resultados Mil doscientos noventa y dos (84,8%) fueron estudiados. La prevalencia serologica (IgM y/o IgG+) a SARS-CoV-2 fue del 17,2% (222/1.292) y del 15,5% (201/1.292) considerando IgG positiva. La edad media fue 44 ± 13 anos, el 73% eran mujeres. El 33,8% (75/222) fueron asintomaticos. Tenian rRT-PCR positiva previa 81. El 14% (32/222) contacto familiar. Conclusion La prevalencia serologica SARS-CoV-2 en los trabajadores de un hospital pediatrico fue mayor que en la poblacion general. Muchos pasaron una infeccion inadvertida.

Anorexia nervosa is an eating disorder frequently associated with cutaneous manifestations. A rare type of purpura, known as diffuse reticulate purpura, has been described in patients with anorexia nervosa and severe malnutrition. Typical characteristics of this condition include a purpuric reticulate rash predominantly affecting the trunk that rapidly resolves with adequate feeding. We report two male adolescent patients with anorexia nervosa and severe malnutrition who developed diffuse reticulate purpura.

Objective Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children. In addition, we have analyzed the association between clinical history and the presence of asthma. Study Design Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7–17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated. Results Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p

The Spanish Digital Services Tax came into force on 16 January 2021 after a long and turbulent journey with the ambition to serve as an interim measure pending the long-awaited multilateral solution. This article aims to critically analyse the main features of the tax and further reveal and assess the primary challenges that its implementation and day-to-day management are likely to prompt, specifically: the vague delimitation of some of its provisions with the subsequent damage to legal certainty, the (almost) unfeasible access to the data required to calculate the relevant taxable revenues that render the tax ultimately unworkable, and the tax planning opportunities that may be exploited by taxpayers to minimize their tax liabilities, inter alia. Finally, the doubtful consistency between the design of the tax and the alleged tax policy guideline behind it (i.e., the ‘value creation’ principle) is assessed. Ultimately, the question remains of whether this path is genuinely worth exploring. Are we really willing to endanger fundamental principles of the rule of law for a temporary patch targeting a few multinationals? Digital services tax, digital economy, value creation, user data, social media, online advertising, sharing economy

The present book chapter seeks to analyze the content of the proposal for Directive launched by the European Commission in March 21st 2018 on the new threshold on significant digital presence that is expected to complement the current permanent establishment concept. It aims to accomplish the following three objectives. Firstly, identify the alleged policy objectives underlying the proposal and further analyze whether it effectively serves to accomplish such objectives. Secondly, analyze the suggested rule so as to anticipate the risks that may arise if implemented in its current form (from the perspective of its interpretation, administration and auditing, inter alia). Thirdly, put forward a number of suggestions that may help mitigate the aforementioned risks or else improve the proposal in some other ways.

The present paper aims to delve into one of the most thrilling debates set out by the Base Erosion and Profit Shifting (BEPS) Project (specifically Action 1): the reconsideration of the permanent establishment threshold.Without disregarding the fiscal interests that have undeniably boosted the reopening of the discussion, we prefer to question the appropriateness of the PE from a different perspective. First, we will analyse the theoretical principles that originally served to justify the PE threshold. Subsequently, we will demonstrate the obsolescence of the term &- as it currently stands &- as a result of the challenges posed by the so-called digital economy and in light of the aforementioned principles. Some proposals for the way forward will be briefly outlined. This research is integrated within the R+D Project DER2013-47912-P (‘Rethinking the structure and concepts of international tax law’)

Revista Pediatria de Atencion Primaria • Vol. XII. N.o 47. Julio/septiembre 2010 Rev Pediatr Aten Primaria. 2010;12:543-6 La maternidad perfecta. La lactancia materna y sus expectativas. Carta de una madre de un nino en su primer mes de vida: “A lo largo de mi embarazo me he llevado varias decepciones para las que no te preparan en las clases de preparacion al parto. En primer lugar, cuando me dijeron que no iba a poder tener un parto natural, ya que el nino estaba sentado y no se iba a poder dar la vuelta. En segundo lugar, cuando despues del nacimiento de mi hijo, no tuve suficiente leche para alimentarle con el pecho. Durante todo mi embarazo tuve muy claro que queria darle el pecho. En las clases de preparacion nos repetian una y otra vez lo importante que era, te ensenan a darlo y te explican las propiedades, sus beneficios, etc. Pero para nada te preparan para las dificultades y el como afrontar el tema psicologicamente en caso de no poder hacerlo. Al igual que solamente te preparan para un parto natural y obvian en todo momento la posibilidad de una cesarea. Por desgracia, mi nino tuvo complicaciones despues de nacer y tuvo que estar en neonatos cuatro dias. Estuve sin poder verlo durante 24 horas, tras las que empezo la odisea de darle el pecho. Cada tres horas iba a darselo. Al principio, entre el dolor de la cesarea, el no saber y el tener a tres o cuatro personas diciendote como hacerlo, las diferentes posturas, etc., entremetiendose al tiempo..., me agobie bastante, aunque entendia que todo lo hacian por mi bien. El nino se enganchaba al pecho, aunque se quedaba con mucha hambre y le La maternidad perfecta. La lactancia materna y sus expectativas E. Panadero Utrillaa, E. Escribano Ceruelob, M. Duelos Marcosc Psicologo Residente (4.o ano). Pediatra. CS Barcelona. Mostoles, Madrid. Espana. Pediatra. CS Guayaba. Madrid. Espana.

Revista Pediatria de Atencion Primaria Volumen XI. Suplemento 15, 2009 La dermatitis atopica (DA) es la enfermedad dermatologica cronica mas frecuente en la infancia y una de las enfermedades pediatricas mas prevalentes. No cabe duda de que en las ultimas tres decadas su incidencia ha ido en aumento, en la misma linea que lo han hecho las enfermedades autoinmunes y alergicas, la llamada epidemia no infecciosa del siglo XXI. Es una enfermedad compleja en la que la genetica y el ambiente estan muy involucrados. Permaneciendo invariable la predisposicion hereditaria, los cambios en el ambiente, la contaminacion y los habitos de higiene parecen tener un papel muy relevante. Esto es especialmente notable en los paises industrializados y mas concretamente en las areas urbanas de los mismos. Los ninos nacidos en un pais pobre presentan un aumento de atopia cuando emigran a un pais rico como el nuestro, sin embargo no sera posible predecir cual sera el curso natural de la enfermedad y muy probablemente este no podra ser modificado. En Espana existen pocos estudios de prevalencia, si bien se estima que puede situarse alrededor del 15% de la poblacion infantil. Existen aun grandes controversias sobre los diferentes factores etiopatogenicos. Muchos de los factores externos que se consideraban muy relevantes en la fisiopatologia de la enfermedad como la lactancia materna, la flora intestinal y el papel de los probioticos y otros alergenos alimentarios han pasado a un lugar menos importante, e incluso se alerta sobre los riesgos de algunos de ellos, para ocupar un lugar mas destacado la genetica y las anomalias intrinsecas de la piel. El diagnostico es exclusivamente clinico y se realiza bien por parte de los pediatras de Atencion Primaria, se habla Dermatitis atopica: una enfermedad emergente

espanolExiste una gran controversia sobre la verdadera utilidad de los cuidados generales habitualmente recomendados a los pacientes atopicos. En general, son pocos los estudios disenados para este fin y como norma general tienen una escasa base cientifica, pocos estudios son controlados y la mayoria de las recomendaciones se basan en opiniones de expertos, a esto se suma que muchas veces estas son contrapuestas. Con la finalidad de ayudar a minimizar el impacto de la enfermedad en la vida del nino y establecer unos cuidados adecuados a cada paciente, es recomendable hablar abiertamente sobre estos temas y acompanar por escrito un plan de autocuidado. EnglishThere is a big controversial over the real efects of skin care in atopic dermatitis that we usually recomend to atopic patients. In general, there are few studies designed in this way and most of them are based in expert opinions, no control trials and the recommendations are in opposition. As a result to reduce the impact of the disease in the children life is advisable to speak friendly about this topics and add a self-care writing plan.

To describe the possible association between demographic, social and economic characteristics of health areas in the autonomous community of Madrid and utilization of public family practice facilities.An ecological study was carried out using health areas as the unit of analysis. The information sources were official data on population statistics and the reports of the National Institute of Health for 1996 and 2001. Indicators were income, mean household size, unemployment rate, the percentage of housewives, and the percentage of individuals with university education. The association between these indicators and utilization of public family practice facilities was analyzed using the Spearman correlation coefficient. A multivariate linear regression model was also fitted.The consultation rate in public family practice facilities in Madrid was directly associated with the percentage of housewives (r = 0.44), income (r = -0,697), and the percentage of individuals with university education (r = -0.72). In the multivariate linear regression model, 77% of the varian-ce in utilization was explained by income (48%), the percentage of housewives (19%), and average household size (9%).The results show the relationship between social and economic factors and utilization of public family practice facilities and suggest the advisability of including demographic and socioeconomic factors in primary care planning.

ResumenObjetivosSe describe la posible asociación entre las características demográficas y socioeconómicas de las áreas sanitarias de la Comunidad de Madrid y la frecuentación de las consultas de medicina de familia de atención primaria.MétodosEstudio ecológico que utiliza el área sanitaria como unidad de análisis. Las fuentes de información fueron los datos oficiales sobre estadísticas de población y las memorias del Instituto Nacional de Salud de los años 1996 y 2001. Como indicadores se obtuvieron el nivel de renta, el tamaño medio del hogar, el paro, la población dedicada a las labores del hogar y la población con estudios superiores, analizándose la asociación con la frecuentación mediante el coeficiente de correlación de Spearman. Se ajustó un modelo multivariante de regresión lineal.ResultadosLa frecuentación a la consulta de medicina de familia se asoció al porcentaje de personas dedicadas a las labores del hogar (r=0,44) a la renta (r=−0,69) y a los estudios superiores (r=−0,72). El modelo multivariante mostró que la variabilidad de la frecuentación se explica en un 77,5% por la inclusión conjunta de la renta (un 48% de la variabilidad), el porcentaje de personas dedicadas a las labores del hogar (19%) y el tamaño del hogar (9%).ConclusionesEstos resultados muestran la existencia de factores socioeconómicos que explican la utilización de las consultas de medicina de familia. Los resultados obtenidos aconsejan que la planificación de los servicios de atención primaria incorpore parámetros demográficos y socioeconómicos.AbstractObjectivesTo describe the possible association between demographic, social and economic characteristics of health areas in the autonomous community of Madrid and utilization of public family practice facilities.MethodsAn ecological study was carried out using health areas as the unit of analysis. The information sources were official data on population statistics and the reports of the National Institute of Health for 1996 and 2001. Indicators were income, mean household size, unemployment rate, the percentage of housewives, and the percentage of individuals with university education. The association between these indicators and utilization of public family practice facilities was analyzed using the Spearman correlation coefficient. A multivariate linear regression model was also fitted.ResultsThe consultation rate in public family practice facilities in Madrid was directly associated with the percentage of housewives (r=0.44), income (r=−0,697), and the percentage of individuals with university education (r=−0.72). In the multivariate linear regression model, 77% of the variance in utilization was explained by income (48%), the percentage of housewives (19%), and average household size (9%).ConclusionsThe results show the relationship between social and economic factors and utilization of public family practice facilities and suggest the advisability of including demographic and socioeconomic factors in primary care planning.

The present article intends to provide alternative solutions beyond the traditional countermeasures to counteract the treaty shopping phenomenon. It departs from the premise that the treaty shopping phenomenon has never been accurately defined, a fact that significantly conditions – and hinders – the process of conceiving measures to address it. Be that as it may, the paper briefly summarizes the key features of its three most paradigmatic countermeasures (beneficial ownership, limitation on benefits (LOBs) clauses and the principal purpose test) and further notes that the recently advocated international expansion of the latter two may not be appropriate (section 1). In this context, the paper advocates for four alternative approaches to neutralize treaty shopping. The first approach involves a reconsideration of domestic corporate tax residence tests, whose configuration ought to be regarded as the genuine ultimate root of treaty shopping concerns (section 2.1). The second and third involve a (re)interpretation and a minor amendment of Article 4.1 of tax treaties respectively (sections 2.2 and 2.3). The last one entails the adoption of a more targeted LOB clause (section 2.4). The first and fourth approaches rely on a specific (and personal) perception of the treaty shopping phenomenon (section 2.1).