RESUMO Irving Fisher ofereceu uma teoria “provisória” de deflação de dívidas de grandes depressões em vez de uma teoria totalmente consistente de seu “credo”: “Eu digo ‘credo’ porque, por brevidade, é expressamente expresso dogmaticamente e sem prova. [...] é bastante tentativa” (Fisher, 1933, p. 337). O artigo argumenta que autores proeminentes que se esforçaram para explicar suas ideias dentro do aparelho walrasiano não poderiam fornecer uma teoria consistente de deflação com depressão prolongada. Isto é basicamente porque as forças de mercado desestabilizadoras não podem dominar nesse quadro conceitual. Em contraste, devido à forma como as forças competitivas operam sob incerteza fundamental, a Teoria Geral de Keynes escapa da contradição.

ABSTRACT Irving Fisher offered a ‘tentative’ debt-deflation theory of great depressions rather than a fully consistent theory of his ‘creed’: “I say ‘creed’ because, for brevity, it is purposely expressed dogmatically and without proof. [...] it is quite tentative” (Fisher 1933, p. 337). The paper argues that prominent authors who strived to explain his ideas within the Walrasian apparatus could not deliver a consistent theory of deflation with protracted depression. This is basically because destabilizing market forces cannot dominate in that conceptual framework. By contrast, owing to the way competitive forces operate under fundamental uncertainty, Keynes’ General Theory escapes the contradiction.

Background: Clinical features of Clostridium difficile infection (CDI) cases diagnosed by detection of polymerase chain reaction (PCR), with negative toxin enzyme immunoassay results (EIA) have not been fully elucidated. The purpose of this study was to determine the magnitude of CDI patients who had negative EIA toxin determinations but positive PCR tests, and their differences in clinical presentation. Methods: We performed a retrospective study comparing the clinical features of CDI cases detected by EIA (toxins A + B) with cases detected by PCR (toxin negative, PCR positive) over a 16-month period. Only patients with an initial Clostridium difficile infection episode that fulfilled a standardized definition were included. Results: During the study period, 107 episodes of CDI were detected. Seventy-four patients (69%) had positive glutamate dehydrogenase (GDH) antigen and EIA determinations (EIA positive patients). Thirty-three patients (31%) had GDH positive, negative toxin EIA and positive PCR determination (PCR positive patients). PCR positive patients were younger, 57 (27) years (mean [SD]), than EIA positive patients, 71 (16) years, (p < 0.001). Fewer PCR positive patients were receiving proton pump inhibitors (21 patients, 64%) than EIA positive patients (61 patients, 82%, p = 0.034). The clinical presentation was similar in both groups. In the multivariate analysis, lower age was identified as the only independent variable associated with PCR positive patients. Conclusions: One third of Clostridium difficile infection patients present negative toxin EIA and PCR positive tests. Performing PCR determination after the negative EIA test is more relevant in younger patients.

The paper explores the issue of fiscal institutions which constitutes a framework for the comparison of budgetary processes and budgetary procedures. Two aspects are considered trying to determine with more accuracy the field of fiscal institutions and fiscal rules, in one side, and a deeper examination of a particular type of institutions, in the other. The analysis is extended, also, to its importance in contexts with various levels of government.

El artículo aborda el tratamiento de las instituciones fiscales que permiten encuadrar la comparación de los procesos presupuestarios. Se esbozan dos notas procurando precisar conceptualmente el campo de las instituciones y reglas fiscales, por un lado, y considerando en mayor detalle un tipo particular de instituciones, por el otro. Además, se extiende el análisis a su importancia en los contextos con varios niveles de gobierno.

Background: Despite the growing incidence of Clostridium difficile diarrhea (CCD) in patients with inflammatory bowel disease (IBD), little is known about the associated risk factors. Method: A retrospective study comparing cases of CCD in patients with IBD to IBD carriers who did not develop CCD. A comparison was also made with patients who developed CCD but did not suffer IBD. Results: Three cases (20 %) with IBD and CCD had received antibiotics during the previous three months versus none of the controls (IBD without CCD, p = 0.22). Ten cases (67 %) received treatment with proton pump inhibitors (PPIs) versus 2 (13 %) in the control group (IBD without CCD, p = 0.001). Seven cases underwent colonoscopy and pseudomembranes were seen in one (14 %). Fourteen (93 %) patients demonstrated a favourable response to metronidazole. Patients with IBD and CCD presented with younger age (36 ± 10 years), a higher degree of community-acquired infection (13 patients, 87 %), immunosuppressive treatment (7 patients, 47 %) and less patients had received previous antibiotic treatment (3 patients, 20 %) than those with CCD without IBD. The proportion of patients who received treatment with PPIs was similar (66 % and 80 %, respectively p = 0.266). Conclusions: CCD in IBD carriers affects younger patients, the majority are community acquired (less nosocomial) and it is more related to previous treatment with PPIs than with the antibiotic treatment. Clinical evolution is also favourable.

Introducción: a pesar de la incidencia creciente de diarrea por Clostridium difficile (DCD) en pacientes con enfermedad inflamatoria intestinal (EII) disponemos de un conocimiento limitado de factores de riesgo. Método: estudio retrospectivo comparando casos de DCD en pacientes con EEI con pacientes portadores de EEI que no desarrollaron DCD. También se realizó una comparación con pacientes que desarrollaron DCD, pero que no padecían EII. Resultados: tres casos (20 %) con EII y DCD habían recibido antibióticos durante los tres meses previos frente a ninguno de los controles (EEI sin DCD, p = 0,22). Diez casos (67 %) estaban recibiendo tratamiento con un inhibidor de la bomba de protones (IBP) frente a dos (13 %) entre los controles (EEI sin DCD, p = 0,001). Se visualizaron pseudomembranas en uno (14 %) de los siete casos en los que se hizo colonoscopia. Hubo respuesta favorable a metronidazol en 14 pacientes (93 %). Los pacientes con EEI y DCD presentaron menor edad (36 ± 10 años), mayor grado de adquisición comunitaria de la infección (13 pacientes, 87 %) y tratamiento inmunosupresor (7 pacientes, 47 %) junto a menos pacientes con tratamiento antibiótico previo (3 pacientes, 20 %) que los pacientes con DCD pero sin EII. La proporción de pacientes que recibían tratamiento con un IBP era similar (66 % y 80 %, respectivamente; p = 0,266). Conclusiones: los casos de DCD en portadores de EEI se caracterizan por afectar a pacientes más jóvenes, mayoritaria adquisición comunitaria (y menor nosocomial), guardar más relación con el tratamiento previo con IBP que con el tratamiento antibiótico y presentar evolución clínica favorable.

The existence of different levels of government which maintain a needed and obliged relationship among them, in particular in federal systems, introduces a series of issues deserving analysis, involving resources and territories. One specific topic refers to the reciprocal flows of public revenue and expenditure which emerges with the central governments, which operates, in general, transferring revenues obtained in the whole geographical system of any country. In such a way, appears a problem of collection and devolution of the alluded revenues which poses the relevancy of the emerging balance. So, methodological aspects occupy a central place. The paper aims to explore the conceptual meaning of the mentioned fiscal balances, to search the significance of them in other contexts and to consider some implications for federative cases, including the Argentinean one.

La existencia de distintos niveles de gobierno y una relación necesaria y forzosa entre ellos, en particular en los sistemas federales, introduce una serie de cuestiones susceptibles de análisis que involucran recursos y territorios. Un aspecto particular refiere a los flujos recíprocos de ingresos y gastos públicos que se suscitan con los gobiernos centrales, los cuales operan, en general, trasvasando ingresos obtenidos en el conjunto de los sistemas geográficos nacionales. En tal sentido, aparece un problema de captura y retorno o remisión y devolución de tales fondos que hace aparecer el problema del saldo como relevante. Luego, las cuestiones metodológicas ocupan un lugar central. El artículo procura explorar la significación conceptual de las mencionadas balanzas fiscales, indagar la acepción asignada a las mismas en otros contextos y considerar algunas implicancias observables para casos federativos, incluso el argentino.

Background: There are not available adequate studies of the costs of Clostridium difficile-associated diarrhea (CDAD) in Spain. The aim of the study is to estimate the cost of CDAD for the National Health Service (NHS). Methods: an economic model was carried out to calculate the cost per episode of CDAD (due to antimicrobials, prolonged hospitalization, surgical procedures, measures to control the infection, recurrences of infections treated) and the CDAD annual cost. Resources use in clinical practice was obtained through a Delphi panel of Spanish clinicians with expertise in CDAD and unit costs (€ 2012) from Spanish Sources. Results: An estimated 7,601 episodes of CDAD occur annually in Spain (incidence of 17.1 episodes/year/10,000 hospital discharges) with an annual cost to the NHS of € 32,157,093. Cost per episode of CDAD: € 3,901 (initial infection), € 4,875 (first recurrence) and € 5,916 (second recurrence). Total cost of recurrences: € 10,426,750 annually. The 95.6% of spending is due to the prolonged hospitalization, 0.5% to antibiotic treatment, 2.8% for surgery and 1.1% for measures of control infection. Study results are sensitive to incidence and case fatality rate of CDAD in Spain and the prolongation of duration of hospital stay due to CDAD. Conclusions: According to this study, the expense associated with CDAD is primarily due to the prolongation of hospitalization and has a great economic impact on the NHS.

Fundamentos: No se dispone de estudios adecuados del coste de las diarreas asociadas a Clostridium difficile (DACD) en España. El objetivo del estudio es estimar el coste de las DACD para el Sistema Nacional de Salud (SNS). Métodos: Se realizó un modelo económico para calcular el coste por episodio de DACD (por antibióticos, prolongación del ingreso hospitalario, procedimientos quirúrgicos, medidas de control de la infección, recurrencias de las infecciones tratadas) y el coste anual de la DACD. El uso de recursos en la práctica clínica se obtuvo mediante un panel Delphi de clínicos españoles con experiencia en la DACD y los costes unitarios (€ 2012) de fuentes españolas. Resultados: Se estimó que anualmente se produjeron 7.601 episodios de DACD en España (incidencia de 17,1 episodios/año/10.000 altas hospitalarias) con un gasto anual para el SNS de 32.157.093 €. Coste por episodio de DACD: 3.901 € (infección inicial), 4.875 € (primera recurrencia) y 5.916 € (segunda recurrencia). Coste total de las recurrencias: 10.426.750 € anuales. El 95,6% del gasto se debería a la prolongación de la duración de la estancia hospitalaria, el 0,5% a tratamientos antibióticos, el 2,8% a intervenciones quirúrgicas y el 1,1% a las medidas de control de la infección. Los resultados del estudio fueron sensibles a la incidencia y tasa de letalidad de la DACD en España y a la duración de la prolongación de la duración de la estancia hospitalaria debida a la DACD. Conclusiones: Según este estudio, el gasto asociado a la DACD se debe fundamentalmente a la prolongación de los ingresos hospitalarios y tiene un gran impacto económico en el SNS.

Background: There are not available adequate studies of the costs of Clostridium difficile-associated diarrhea (CDAD) in Spain. The aim of the study is to estimate the cost of CDAD for the National Health Service (NHS). Methods: an economic model was carried out to calculate the cost per episode of CDAD (due to antimicrobials, prolonged hospitalization, surgical procedures, measures to control the infection, recurrences of infections treated) and the CDAD annual cost. Resources use in clinical practice was obtained through a Delphi panel of Spanish clinicians with expertise in CDAD and unit costs (€ 2012) from Spanish Sources. Results: An estimated 7,601 episodes of CDAD occur annually in Spain (incidence of 17.1 episodes/year/10,000 hospital discharges) with an annual cost to the NHS of € 32,157,093. Cost per episode of CDAD: € 3,901 (initial infection), € 4,875 (first recurrence) and € 5,916 (second recurrence). Total cost of recurrences: € 10,426,750 annually. The 95.6% of spending is due to the prolonged hospitalization, 0.5% to antibiotic treatment, 2.8% for surgery and 1.1% for measures of control infection. Study results are sensitive to incidence and case fatality rate of CDAD in Spain and the prolongation of duration of hospital stay due to CDAD. Conclusions: According to this study, the expense associated with CDAD is primarily due to the prolongation of hospitalization and has a great economic impact on the NHS.

Fundamentos: No se dispone de estudios adecuados del coste de las diarreas asociadas a Clostridium difficile (DACD) en España. El objetivo del estudio es estimar el coste de las DACD para el Sistema Nacional de Salud (SNS). Métodos: Se realizó un modelo económico para calcular el coste por episodio de DACD (por antibióticos, prolongación del ingreso hospitalario, procedimientos quirúrgicos, medidas de control de la infección, recurrencias de las infecciones tratadas) y el coste anual de la DACD. El uso de recursos en la práctica clínica se obtuvo mediante un panel Delphi de clínicos españoles con experiencia en la DACD y los costes unitarios (€ 2012) de fuentes españolas. Resultados: Se estimó que anualmente se produjeron 7.601 episodios de DACD en España (incidencia de 17,1 episodios/año/10.000 altas hospitalarias) con un gasto anual para el SNS de 32.157.093 €. Coste por episodio de DACD: 3.901 € (infección inicial), 4.875 € (primera recurrencia) y 5.916 € (segunda recurrencia). Coste total de las recurrencias: 10.426.750 € anuales. El 95,6% del gasto se debería a la prolongación de la duración de la estancia hospitalaria, el 0,5% a tratamientos antibióticos, el 2,8% a intervenciones quirúrgicas y el 1,1% a las medidas de control de la infección. Los resultados del estudio fueron sensibles a la incidencia y tasa de letalidad de la DACD en España y a la duración de la prolongación de la duración de la estancia hospitalaria debida a la DACD. Conclusiones: Según este estudio, el gasto asociado a la DACD se debe fundamentalmente a la prolongación de los ingresos hospitalarios y tiene un gran impacto económico en el SNS.

Contrasting with the 1929 great crisis, authorities intervened forcefully in 2008 to stop the disintegration of the financial system. Governments and central banks then sought to revise the prudential regulation in depth. It would be optimistic, however, to believe that prudential measures, alone, could deliver full economic recovery, at least in the countries that had been involved in the financial turmoil. Indeed, the collapse of the "state of confidence" and the negative effects of private debts on consumption and investment decisions have fed depressive forces and policy challenges which could hold for a while, even once the financial sector is made safe. On the one hand, the economic slowdown and the direct and indirect assistance provided by the governments to the private sectors are having a heavy impact on public finances, meanwhile, on the other hand, the massive amounts of money which artificially inflated the prices of housing and financial products could produce inflationary pressures in the post-crisis period, unless a new assets bubble is allowed for. Authorities could therefore be facing high unemployment in a damaged context of public deficits and inflationary pressures. The paper aims at discussing these new challenges. The inadequacy of inflation targets and fiscal orthodoxy in a depressed economy is emphasized, and the outlines of a Post Keynesian alternative policy are examined.

The paper presents the main arguments of Bresser Pereira's Globalization and Competition. Development strategies based on the 'conventional orthodoxy' are shown to carry serious drawbacks ("Dutch disease", pernicious effects of external saving, currency overvaluation), while a 'new developmentalism' is promoted, in spite of the widespread belief that the nation-states have been dispossessed of their room for manoeuvre because of the globalization process. The "new developmentalism" is based on domestic finance, balanced public budgets, moderate interest rates and competitiveness policies aimed at neutralizing the tendency to exchange rate overappreciation. The paper also points out a few theoretical questions the book raises.

In Spain environmental surveillance has mainly relied on measures of selected pollutants in air, water, food and soil. A study was conducted in Madrid to assess the feasibility of implementing a surveillance system of exposure among the general population to specific environmental pollutants, using bio-markers. The project was basically focused on the environment surrounding newborns. Hence, the study population was made up of 145 triplets of pregnant women at around 8 months' gestation, their partners, and newborns from two areas, representing the two main types of urban environments in the region, i.e., the City of Madrid and its outlying metropolitan belt. Multiple biologic substrates were collected from each participant in order to assess the most suitable samples for an environmental surveillance system. The selected contaminants represent the main agents to which a population like that of Madrid is exposed every day, including certain heavy metals, persistent organic pollutants and polycyclic aromatic hydrocarbons, as well as micronuclei in peripheral blood, a commonly used unspecific index of cytogenetic damage. In addition, passive air samplers were placed around subjects' place of residence. This paper reports in detail on the design and response rates, summarizes field work results, and discusses some lessons learned.

En España, la vigilancia medioambiental se basa principalmente en medidas de ciertos contaminantes en muestras de aire, agua, alimentos y suelos. En Madrid se ha realizado un estudio para valorar la posibilidad de poner en marcha un sistema de vigilancia de exposiciones a contaminantes ambientales en la población general utilizando biomarcadores. El proyecto ha tenido como eje el estudio del entorno de los recién nacidos. Por tanto, la población de estudio la constituyen 145 «tríos» formados por mujeres en su octavo mes de embarazo, sus parejas y los recién nacidos de dos áreas geográficas, que representan los dos principales entornos urbanos de la región, es decir, Madrid capital y su área metropolitana. Se recogieron múltiples sustratos biológicos de cada participante con el objeto de valorar las muestras más adecuadas para un sistema de vigilancia de exposiciones ambientales. Los contaminantes elegidos representan los principales agentes tóxicos a los que una población como la de Madrid está expuesta diariamente, e incluyen metales pesados, contaminantes orgánicos persistentes e hidrocarburos aromáticos policíclicos; se ha añadido también una medida inespecífica de daño citogenético, los micronúcleos en sangre periférica. Además, se han colocado muestreadores pasivos de aire en los alrededores del domicilio de los participantes. Este artículo describe en detalle el diseño del estudio y la tasa de respuesta, resumen los resultados del trabajo de campo y comenta algunas enseñanzas prácticas de éste.

In Spain environmental surveillance has mainly relied on measures of selected pollutants in air, water, food and soil. A study was conducted in Madrid to assess the feasibility of implementing a surveillance system of exposure among the general population to specific environmental pollutants, using bio-markers. The project was basically focused on the environment surrounding newborns. Hence, the study population was made up of 145 triplets of pregnant women at around 8 months' gestation, their partners, and newborns from two areas, representing the two main types of urban environments in the region, i.e., the City of Madrid and its outlying metropolitan belt. Multiple biologic substrates were collected from each participant in order to assess the most suitable samples for an environmental surveillance system. The selected contaminants represent the main agents to which a population like that of Madrid is exposed every day, including certain heavy metals, persistent organic pollutants and polycyclic aromatic hydrocarbons, as well as micronuclei in peripheral blood, a commonly used unspecific index of cytogenetic damage. In addition, passive air samplers were placed around subjects' place of residence. This paper reports in detail on the design and response rates, summarizes field work results, and discusses some lessons learned.

En España, la vigilancia medioambiental se basa principalmente en medidas de ciertos contaminantes en muestras de aire, agua, alimentos y suelos. En Madrid se ha realizado un estudio para valorar la posibilidad de poner en marcha un sistema de vigilancia de exposiciones a contaminantes ambientales en la población general utilizando biomarcadores. El proyecto ha tenido como eje el estudio del entorno de los recién nacidos. Por tanto, la población de estudio la constituyen 145 «tríos» formados por mujeres en su octavo mes de embarazo, sus parejas y los recién nacidos de dos áreas geográficas, que representan los dos principales entornos urbanos de la región, es decir, Madrid capital y su área metropolitana. Se recogieron múltiples sustratos biológicos de cada participante con el objeto de valorar las muestras más adecuadas para un sistema de vigilancia de exposiciones ambientales. Los contaminantes elegidos representan los principales agentes tóxicos a los que una población como la de Madrid está expuesta diariamente, e incluyen metales pesados, contaminantes orgánicos persistentes e hidrocarburos aromáticos policíclicos; se ha añadido también una medida inespecífica de daño citogenético, los micronúcleos en sangre periférica. Además, se han colocado muestreadores pasivos de aire en los alrededores del domicilio de los participantes. Este artículo describe en detalle el diseño del estudio y la tasa de respuesta, resumen los resultados del trabajo de campo y comenta algunas enseñanzas prácticas de éste.

The paper deals with some particular issues about federalism. One of them and not so obvious is the conceptual one. It is remembered that federalism not always was treated with the same meaning. The mean characters are exposed jointly, signaling besides the different types of political associations inside which it is possible to include clearly the modern federations. Additionally, the author devotes space to consider some other issues related, like the frequent appearance of assimetries and imbalances to the interior of federations. The former poses one of the biggest challenges to the operation and equilibrium in the contemporary scenarios where the federal form of governance matters. In the other side, the particular problem of fiscal imbalances open doors to the main issue of fiscal federal relations, which involves the central issues of expenditure assignment, tax assignment and transfers, as basic features of fiscal federalism. The paper includes some considerations about the Argentinean scenario and concludes with some comments summarizing the general content of the note.

El artículo se ocupa de algunos aspectos particulares del federalismo. Uno de ellos y quizás nada obvio es el conceptual. Se recuerda que el federalismo no siempre ha sido tratado con el mismo sentido. Se exponen los principales caracteres conjuntamente, señalando además los diferentes tipos de asociación política dentro de las cuales es posible incluir claramente las modernas federaciones. Las mismas plantean uno de los más grandes desafíos para la operación y el equilibrio en los escenarios contemporáneos donde la forma federal de gobernanza importa. Por otra parte, el problema particular de los desbalances fiscales abre las puertas a la cuestión principal de las relaciones fiscales federales, que envuelve los tópicos centrales de asignación de funciones, asignación de recursos y transferencias, como patrones básicos de federalismo fiscal. La contribución incluye algunas consideraciones acerca del escenario argentino y concluye con algunos comentarios sumarizando el contenido general de la nota.