RESUMEN Este artículo aborda la configuración de la sociedad de riesgo globalizada y sus efectos en el orden jurídico criminal de Brasil. El aumento de pautas de seguridad, incluso con la mitigación de los derechos humanos fundamentales, se problematiza a fin de reflejar el sistema penitenciario y el surgimiento del monitoreo electrónico como condición de posibilidad para reducir el encarcelamiento masiva en el país. El problema que guía la investigación se puede resumir en la siguiente pregunta: ¿en qué medida el monitoreo electrónico contribuye efectivamente a reducir el número de personas encarceladas en Brasil? El método de investigación utilizado es hipotético-deductivo, con técnica de investigación bibliográfica y análisis documental. Como resultado, la investigación encuentra que el uso del monitoreo electrónico, como lo demuestran las estadísticas del diagnóstico de la política de monitoreo electrónico en Brasil, representa una medida importante para minimizar los efectos del encarcelamiento masivo en el sistema penitenciario nacional.

ABSTRACT This article tackles the configuration of the globalized risk society and its effects in the criminal-judicial order in Brazil. The rising of security guidelines, even with the mitigation of fundamental human rights, are problematized with the goal of reflecting the prison system and the surging of electronic monitoring as a condition of possibility for reducing the massive incarceration in the country. The problem that guides this investigation can su summarized in the following question: to what extent does electronic monitoring contribute to reducing the number of incarcerated people in Brazil? The employed method is the hypothetical-deductive one with bibliographic and document analysis techniques. As a result, the research found that the use of electronic monitoring, as shown by the statistics of the diagnosis made to the electronic monitoring policy in Brazil, represents an important measure for minimizing the effects of massive incarceration in the national penitentiary system.

RESUMO O presente artigo aborda a configuração da sociedade de risco globalizada e os seus efeitos na ordem jurídica criminal do Brasil. A ascensão de pautas securitárias, mesmo com a mitigação de direitos humanos e fundamentais, é problematizada com o objetivo de refletir o sistema carcerário e a emergência da monitoração eletrônica como condição de possibilidade à redução do encarceramento em massa no País. O problema que orienta a pesquisa pode ser sintetizado na seguinte interrogante: em que medida a monitoração eletrônica contribui, efetivamente, para o enfrentamento à questão do número de pessoas encarceradas no Brasil? O método de pesquisa utilizado na investigação é o hipotético-dedutivo, com técnica de pesquisa bibliográfica e análise documental. Como resultado, a pesquisa constata que a utilização da monitoração eletrônica, como demonstram as estatísticas do Diagnóstico da Política de Monitoração Eletrônica no Brasil, representa uma medida importante para minimizar os efeitos do encarceramento massivo no sistema penitenciário nacional.

RESUMO Este estudo tem por objetivo desenvolver um método que possa ser adotado por seguradoras para avaliar o ajuste de risco para os riscos não financeiros (AR) exigido pela Norma Internacional de Contabilidade 17 (IFRS 17). Diferentemente de outros métodos, o método aqui proposto retorna diretamente o AR para cada passivo relacionado com um grupo de contratos de seguro: cobertura remanescente e sinistros ocorridos. Além disso, cada parte do AR é alocada corretamente ao passivo atuarial correspondente, o que constitui uma vantagem diante dos demais métodos. O método segue as diretrizes da IFRS 17 e contribui com a padronização das práticas contábeis das seguradoras no mundo inteiro, aumentando assim o grau de comparabilidade entre as demonstrações financeiras nas diferentes jurisdições. Este estudo deve ser considerado relevante pelas companhias de seguros, pelos supervisores e reguladores do mercado de seguros e pela maioria dos profissionais envolvidos. O método se vale da teoria do risco coletivo e da técnica de simulação de Monte Carlo para ajustar as distribuições probabilísticas adotadas para calcular dois diferentes fatores de carregamento que, quando aplicados ao valor contábil dos prêmios não ganhos e ao valor presente esperado dos sinistros ocorridos, resultam diretamente no AR para cada passivo relacionado com um grupo de contratos de seguro: coberturas remanescentes e sinistros ocorridos. Nossos resultados mostram que, para carteiras de grande porte, vale o teorema do limite central e as distribuições usadas para avaliar os fatores de carregamento podem ser bem aproximadas pela distribuição normal. Adicionalmente, os valores obtidos para cada fator de carregamento são baixos, o que significa que o AR é relativamente baixo quando comparado ao valor contábil dos prêmios não ganhos e ao valor presente esperado dos sinistros ocorridos. Esse resultado se alinha à lei dos grandes números, que estabelece que, para carteiras de grande porte, o risco assumido pela seguradora se torna consideravelmente menor, pois é mais fácil prever o comportamento dos sinistros futuros agregados.

ABSTRACT This paper aims to develop a method that can be adopted by insurers to assess the risk adjustment for nonfinancial risks (RA) required by International Financial Reporting Standards 17 (IFRS 17). Unlike other methods, the method proposed here directly returns the RA for each liability related to a group of insurance contracts: remaining coverage and incurred claims. Moreover, each portion of the RA is correctly allocated to the corresponding actuarial liability, which constitutes an advantage over other methods. The method follows IFRS 17 directives and contributes to standardize accounting practices of insurers around the world, thus increasing the degree of comparability between financial statements in different jurisdictions. This paper should be relevant for insurance companies, for insurance market supervisors and regulators, as well as for practitioners in general. The method takes advantage of the collective risk theory and of the Monte Carlo simulation technique to adjust probability distributions used to calculate two different loading factors that, when applied to the carrying amount of unearned premiums and to the expected present value of incurred claims, directly return the RA for each liability related to a group of insurance contracts: remaining coverage and incurred claims. Our results show that, for large-scale portfolios, the central limit theorem holds and the distributions used to assess the loading factors can be well approximated by the normal distribution. Additionally, the values obtained for each loading factor are small, which means that the RA is relatively low when compared to the carrying amount of unearned premiums and to the expected present value of incurred claims. This result is in line with the law of large numbers, which states that, for large-scale portfolios, the risk borne by the insurer becomes considerably lower, since it is easier to predict the behavior of aggregate future claims.

RESUMO Objetivo: viabilizar a proposição de um novo método, a Meta Atuarial Consistente (MAC), que evita, ajustando-as, metas atuariais incompatíveis nos fundos de pensão, após investigar e comprovar, na pesquisa, que a meta dissocia-se da regra geral dos normativos vigentes, que adere essa meta à expectativa de rentabilidade dos investimentos do plano de previdência. Metodologia: foi elaborada uma amostra contendo dados de 22 planos BD, onde aplicou-se a MAC depois de os métodos de dados em painel identificarem os elementos que influenciam a definição da meta atuarial ocorrida no conselho deliberativo dos respectivos fundos de pensão. Resultados: a utilização da MAC, adequando as metas atuariais de 2018 a partir dos vieses sistemáticos ocorridos nas metas anteriores, possibilitou um efeito positivo que se desdobra em estimativas mais fidedignas para as provisões matemáticas dos planos, ao mesmo tempo que identificou elementos que influenciam na determinação do valor da meta anual, provocando sua não aderência à regra geral da legislação. Conclusões: a adoção da MAC pela Previc aperfeiçoaria o regramento e forneceria subsídios para melhor adequar os níveis de contribuição praticados nos planos, tornando mais fidedignos seus níveis de solvência, o que beneficiaria o desenvolvimento do mercado de seguros e de previdência.

ABSTRACT Objective: this article proposes the meta atuarial consistente (MAC) (consistent actuarial rate), which is a method that adjusts incompatible actuarial rates in pension funds, after investigating and proving that the rate dissociates from the general rule in current regulations (which binds this rate to the expected return of the investments of pension funds). Methodology: a sample with data from 22 defined-benefit plans was collected, and MAC was applied to produce consistent actuarial rates, after panel data methods have identified the elements that influence the definition of the actuarial rate by the pension fund board of trustees. Results: the use of MAC, adjusting actuarial rates of 2018 based on systematic biases in previous rates, enabled a positive effect that unfolds in more reliable estimates for the plans’ mathematical provision, while identifying elements that influence the determination of the annual rate, causing its non-compliance to the general rule. Conclusion: the adoption of MAC by the Brazilian supervisory authority Previc would improve the rules and provide subsidies to better adjust the contribution levels practiced in the plans, making their solvency levels more reliable, which would benefit the development of the insurance and pension market.

Abstract Objective To ascertain the survival by stage of cervical cancer in Mallorca (Spain), to explore factors collected by the Mallorcan Cancer Registry associated with survival, and to determine the distribution of cervical cases by stage. Method Retrospective follow-up study of cases diagnosed with cervical cancer between 2006 and 2012 through the Mallorcan Cancer Registry. Cases identified only by death certificate were excluded. Variables: age; date and method of diagnosis; histology (ICD-O 3rd ed.); TNM and stage (UICC 7th ed.); date of follow-up or death and cause of death. Follow-up ended on 31 of December 2015. Multiple imputation was used for missing stage cases. Actuarial and Kaplan-Meier methods were used for survival analysis and Cox regression models to identify factors that explain and predict survival. Results 321 cases were identified. The stage was missing in 8.4% of cases. After multiple imputation, 42.63% were stage I, 24.01% stage II, 19.94% stage III and 13.42% stage IV. Survival was 63% at 5 years: 92% for women diagnosed in stage I, 59% in stage II, 37% in stage III and 18% in stage IV. Stage and age were associated to survival. Conclusions Diagnosis of cervical cancer in stage I is essential. Less than half of the women were diagnosed in stage I. Cervical cancer screening programmes must be improved.

Resumen Objetivo Determinar la supervivencia por estadio del cáncer cervical en Mallorca, identificar los factores recogidos por el Registro de Cáncer de Mallorca asociados a la supervivencia y conocer la distribución de los casos por estadios. Método Estudio retrospectivo de casos diagnosticados con cáncer cervical entre 2006 y 2012 a través del Registro de Cáncer de Mallorca. Se excluyeron los casos identificados solo por certificado de defunción. Variables: edad, fecha y método de diagnóstico, histología (ICD-O 3.ª ed.); TNM y etapa (UICC 7.ª ed.), fecha de seguimiento o muerte, y causa de muerte. El seguimiento finalizó el 31 de diciembre de 2015. Se aplicó la imputación múltiple para los casos cuyo estadio era desconocido. Se utilizaron los métodos actuarial y de Kaplan-Meier para el análisis de la supervivencia, y la regresión de Cox para identificar los factores que explican y predicen la supervivencia. Resultados Se identificaron 321 casos. En el 8,4% se desconocía el estadio. Después de la imputación múltiple, el 42,63% estaban en estadio I, el 24,01% en estadio II, el 19,94% en estadio III y el 13,42% en estadio IV. La supervivencia fue del 63% a los 5 años: 92% para el estadio I, 59% para el estadio II, 37% para el estadio III y 18% para el estadio IV. El estadio y la edad fueron los factores asociados a la supervivencia. Conclusiones El diagnóstico de cáncer de cuello uterino en estadio I es esencial. Menos de la mitad de las mujeres fueron diagnosticadas en estadio I. Es necesario mejorar los programas de cribado del cáncer de cuello uterino.

Abstract Objective To ascertain the survival by stage of cervical cancer in Mallorca (Spain), to explore factors collected by the Mallorcan Cancer Registry associated with survival, and to determine the distribution of cervical cases by stage. Method Retrospective follow-up study of cases diagnosed with cervical cancer between 2006 and 2012 through the Mallorcan Cancer Registry. Cases identified only by death certificate were excluded. Variables: age; date and method of diagnosis; histology (ICD-O 3rd ed.); TNM and stage (UICC 7th ed.); date of follow-up or death and cause of death. Follow-up ended on 31 of December 2015. Multiple imputation was used for missing stage cases. Actuarial and Kaplan-Meier methods were used for survival analysis and Cox regression models to identify factors that explain and predict survival. Results 321 cases were identified. The stage was missing in 8.4% of cases. After multiple imputation, 42.63% were stage I, 24.01% stage II, 19.94% stage III and 13.42% stage IV. Survival was 63% at 5 years: 92% for women diagnosed in stage I, 59% in stage II, 37% in stage III and 18% in stage IV. Stage and age were associated to survival. Conclusions Diagnosis of cervical cancer in stage I is essential. Less than half of the women were diagnosed in stage I. Cervical cancer screening programmes must be improved.

Resumen Objetivo Determinar la supervivencia por estadio del cáncer cervical en Mallorca, identificar los factores recogidos por el Registro de Cáncer de Mallorca asociados a la supervivencia y conocer la distribución de los casos por estadios. Método Estudio retrospectivo de casos diagnosticados con cáncer cervical entre 2006 y 2012 a través del Registro de Cáncer de Mallorca. Se excluyeron los casos identificados solo por certificado de defunción. Variables: edad, fecha y método de diagnóstico, histología (ICD-O 3.ª ed.); TNM y etapa (UICC 7.ª ed.), fecha de seguimiento o muerte, y causa de muerte. El seguimiento finalizó el 31 de diciembre de 2015. Se aplicó la imputación múltiple para los casos cuyo estadio era desconocido. Se utilizaron los métodos actuarial y de Kaplan-Meier para el análisis de la supervivencia, y la regresión de Cox para identificar los factores que explican y predicen la supervivencia. Resultados Se identificaron 321 casos. En el 8,4% se desconocía el estadio. Después de la imputación múltiple, el 42,63% estaban en estadio I, el 24,01% en estadio II, el 19,94% en estadio III y el 13,42% en estadio IV. La supervivencia fue del 63% a los 5 años: 92% para el estadio I, 59% para el estadio II, 37% para el estadio III y 18% para el estadio IV. El estadio y la edad fueron los factores asociados a la supervivencia. Conclusiones El diagnóstico de cáncer de cuello uterino en estadio I es esencial. Menos de la mitad de las mujeres fueron diagnosticadas en estadio I. Es necesario mejorar los programas de cribado del cáncer de cuello uterino.

Abstract: According to previous research carried out on mortality in Ecuador, the country has life tables drawn from the 2001 census data, however, there are no updated tables. Although mortality tables are usually analyzed by sex, there are other factors that are influential. This research goal is to identify whether factors such as sex and the area of residence influence the survival of the population of mainland Ecuador by 2010.To determine the factors that influence the survival of the population, the Logistic Regression technique was used, and for the construction of the mortality tables, the classic actuarial method is used. The analysis shows that sex, area of residence and its interaction, affect the survival of the population.

Resumen: Según investigaciones anteriores realizadas sobre mortalidad en Ecuador, existen tablas de mortalidad elaboradas de los datos del censo de 2001; sin embargo, no hay tablas actualizadas. Aunque las tablas de mortalidad son usualmente analizadas por sexo, existen otros factores que son influyentes. El objetivo de esta investigación es identificar si los factores tales como el sexo y el área de residencia influyen en la supervivencia de la población continental del Ecuador para 2010. A fin de determinar los factores que son influyentes en la supervivencia de la población fue utilizada la técnica de regresión logística y para la construcción de las tablas de mortalidad se utilizó el método clásico actuarial. El análisis muestra que el sexo, el área de residencia y su interacción, afectan la supervivencia de la población.

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher’s exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

Abstract Objective: We aimed to present clinical features, surgical approaches, importance of surgical technique and long-term outcomes of our patients with cardiac myxoma who underwent surgery. Methods: We retrospectively collected data of patients with cardiac myxoma who underwent surgical resection between February 1990 and November 2014. Biatrial approach is the preferred surgical method in a large proportion of patients that are operated due to left atrial myxoma because it provides wider exposure than the uniatrial approach. To prevent recurrence during surgical resection, a large excision is made so as to include at least 5 mm of normal area from clean tissue around the tumor. Moreover, special attention is paid to the excision that is made as a whole, without digesting the fragment of tumor with gentle dissections. Results: Forty-three patients (20 males, mean age of 51.7±8.8 years) were included. Most common symptom was dyspnea (48.8%). Tumor was located in the left atrium in 37 (86%) patients. Resections were achieved via biatrial approach in 34 patients, uniatrial approach in 8 patients, and right atriotomy with right ventriculotomy in 1 patient. One patient died due to low cardiac output syndrome in the early postoperative period. Mean follow-up time was 102.3±66.5 months. Actuarial survival rates were 95%, 92% and 78% at five, 10 and 15 years, respectively. Recurrence was observed in none of the patients during follow-up. Conclusion: Although myxomas are benign tumors, due to embolic complications and obstructive signs, they should be treated surgically as soon as possible after diagnosis. To prevent recurrence, especially in cardiac myxomas which are located in left atrium, preferred biatrial approach is suggested for wide resection of the tumor and to avoid residual tumor.

ResumenSe presenta una descripción del uso del método de las Cadenas de Markov por Monte Carlo para realizar las proyecciones demográficas actuariales, tomando como insumo las tablas de mortalidad, invalidez, mortalidad para inválidos para la población activa del fondo de pensiones del Magisterio Nacional de Costa Rica. Se incluyen ejemplos de la forma en que se implementa el método en la Junta de Pensiones y Jubilaciones del Magisterio Nacional de Costa Rica, que son parte de la información clave para la realización de las Valuaciones Actuariales del Régimen de Pensiones de los educadores.

AbstractA description of the method of Monte Carlo Markov Chains is presented for actuarial demographic forecast, in regard to the mortality, disability, mortality of disabled lives among others. We include examples of how the method is implemented in the Pensions and Retirements Fund for Teachers in Costa Rica, as a input for the results of the actuarial valuation of the pension plan.

Abstract Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. Objectives 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. Patients and method Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. Results Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤ 2 mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 23%, and for Norwood operation 21.3%. For the period between 2000-2005, surgical mortality at the first stage was 36%, and between 2005-2010, 15% (P = .05). Actuarial survival was 64% at one year, and 57% at 5 years. Using a multivariate analysis, a restrictive ASD and a diminutive aorta were high risk factors for mortality. Conclusions Our immediate and long term outcome for staged surgical management of HLHS is similar to that reported by large centres. There is an improvement in surgical mortality in the second half of our experience. Risk factors for mortality are also identified.

Resumen El síndrome de hipoplasia de corazón izquierdo (SHCI) es una cardiopatía congénita con letalidad superior al 95%. La etapificación quirúrgica es la principal vía de tratamiento, y se inicia con la operación de Norwood; la sobrevida a largo plazo de los pacientes tratados es desconocida en nuestro medio. Objetivos 1) Revisar nuestra experiencia en el manejo de todos los pacientes con SHCI evaluados entre enero 2000 y junio 2010. 2) Identificar factores de riesgo de mortalidad quirúrgica. Pacientes y método Estudio retrospectivo de una única institución con una cohorte de pacientes con SHCI. Se revisan antecedentes clínicos, quirúrgicos, y registros de seguimiento. Resultados Se evaluaron 76 pacientes con SHCI; 9/76 tenían comunicación interauricular (CIA) restrictiva, y 8/76, aorta ascendente de < 2 mm; 65/76 fueron tratados: 77% tuvieron operación de Norwood con conducto entre ventrículo derecho y ramas pulmonares como fuente de flujo pulmonar, 17% Norwood con shunt de Blalock-Taussig, y 6% otra cirugía. La mortalidad en la primera etapa quirúrgica fue del 23%, y en operación de Norwood, del 21,3%. En el período 2000-2005 la mortalidad en la primera etapa quirúrgica fue del 36%, y entre 2005-2010, del 15% (p = 0,05). La sobrevida global fue del 64% a un año y del 57% a 5 años. Por análisis multivariado fueron factores de riesgo para mortalidad la presencia de aorta ascendente diminuta y CIA restrictiva. Conclusiones Nuestros resultados inmediatos y a largo plazo en la etapificación quirúrgica de SHCI son similares a la experiencia de grandes centros. Hay una mejoría en mortalidad operatoria en la segunda mitad de la serie. Se identifican factores de riesgo de mortalidad.

Abstract Introduction: There are different strategies to analyse mortality in peritoneal dialysis (PD) with different definitions for case, event, time at risk, and statistical tests. A common method for the different registries would enable proper comparison to better understand the actual differences in mortality of our patients. Methods: We review and describe the analysis strategies of regional, national and international registries. We include actuarial survival, Kaplan-Meier (KM) and competitive risk (CR) analyses. We apply different approaches to the same database (GCDP), which show apparent differences with each method. Results: A total of 1,890 incident patients in PD from 2003-2013 were included (55 years; men 64.2%), with initial RRF of 7ml/min; 25% had diabetes and a Charlson index of 3 [2-4]; 261 patients died, 380 changed to haemodialysis (HD) and 682 received a transplant. Annual mortality rates varied up to 20% in relative numbers (6.4 vs. 5.2%) depending on the system applied. The estimated probability of mortality measured by CR progressively differs from the KM over the years: 3.6 vs. 4.0% the first year, then 9.0 vs. 11.9%, 15.6 vs. 28.3%, and 18.5 vs. 43.3% the following years. Conclusions: Although each method may be correct in themselves and express different approaches, the final impression left on the reader is a number that under/overestimates mortality. The CR model better expresses the reality of PD, where the number of patients lost to follow-up (transplant, transfer to HD) it is 4 times more than deceased patients and only a quarter remain on PD at the end of follow up.

Resumen Introducción: Existen distintas estrategias para analizar la mortalidad en diálisis peritoneal (DP), con diferentes definiciones de caso, evento, tiempo en riesgo y análisis estadístico. Un método común entre los distintos registros permitiría compararlos adecuadamente y entender mejor las diferencias reales de mortalidad de nuestros pacientes. Métodos: Revisamos y describimos las estrategias de análisis de los registros autonómicos, nacional e internacionales. Incluimos análisis de supervivencia actuarial, Kaplan-Meier (KM) y riesgos-competitivos (RC). Aplicamos los diferentes enfoques a la misma base de datos (GCDP), lo que permite mostrar las diferencias aparentes con cada método. Resultados: Se incluyeron 1.890 pacientes incidentes en DP en el periodo 2003-2013 (55 años; 64,2% varones), con FRR inicial de 7ml/min; el 25% presentaba diabetes y un índice de Charlson de 3 [2-4]. Fallecieron 261 pacientes, 380 pasaron a hemodiálisis (HD) y 682 recibieron trasplante. Las tasas de mortalidad anual llegan a variar hasta un 20% en números relativos (6,4 vs. 5,2%) según el sistema aplicado. La estimación de probabilidad de mortalidad por RC es inferior a KM en todos los años: 3,6 vs. 4,0% el 1.er año; 9,0 vs. 11,9%; 15,6 vs. 28,3% y 18,5 vs. 43,3% los siguientes. Conclusiones: Aunque cada método pueda ser correcto en sí mismo y expresar diferentes enfoques, la impresión final que queda en el lector es un número que sobrestima la mortalidad. El modelo de RC expresa mejor la realidad en DP, donde el número de pacientes que pierden seguimiento (trasplante, paso a HD) cuadruplica al de los fallecidos y solo una cuarta parte continúa en DP al final del seguimiento.

Este trabalho tem como objetivo identificar a percepção dos alunos de graduação da Faculdade de Economia e Administração da Pontifícia Universidade Católica de São Paulo (FEA-PUC) com relação à infraestrutura e, em especial, a biblioteca. Utilizou-se o método survey de pesquisa para levantar os dados e abordagem quantitativo-qualitativa. Os resultados demonstraram que a biblioteca central da PUC atende às expectativas dos alunos da Instituição na avaliação quantitativa (N=450), mas na avaliação qualitativa (N=18), o acervo da biblioteca relacionado aos cursos de Administração, Ciências Econômicas, Ciências Contábeis e Atuariais oferece parcialmente suporte as atividades de ensino, pesquisa ou extensão.

This study aims to identify the perception of undergraduate students of the Faculty of Economics and Administration with respect to infrastructure and, in particular, the library. We used the survey research method to collect data and quantitative-qualitative approach. The results showed that the central library of the Pontifical Catholic University of São Paulo (PUC-SP) meets the expectations of students of the institution in the quantitative assessment (N=450), but the qualitative evaluation (N=18), the assets of PUC-SP library related to courses in Administration, Economics, Accounting and Actuarial Sciences offers partially support the activities of teaching, research and extension.

Introdução: A duração média do aleitamento materno ainda é insuficiente e apresenta grandes variações em razão do local e das características da população estudada.Objetivo: Analisar os fatores associados ao desmame em crianças sul brasileiras de comunidades de baixa renda.Material e método: Estudo transversal realizado através de entrevista envolvendo 124 mães de crianças com até 12 meses de idade, atendidas pela Pastoral da Criança, em Almirante Tamandaré, Paraná, Brasil. O risco ao desmame foi considerado como variável resposta e os dados do questionário, variáveis preditoras. Os dados foram analisados através do método de Kaplan-Meier, modelo de regressão de Cox e correlação de Spearman (α = 0,05).Resultado: A tábua de vida atuarial revelou uma probabilidade condicional de desmame maior aos 12 meses de idade, seguido do primeiro e quarto meses. A análise multivariada mostrou que o contato com a mamadeira antes do sexto mês de vida [HR=17,16 (2,34-125,86)] e o contato com a chupeta antes do sexto mês de vida [HR=3,48 (1,90-6,38)] foram variáveis de risco associadas ao desmame. Entre as crianças desmamadas, por ocasião da entrevista, a duração da amamentação apresentou correlação positiva com a idade do primeiro contato com açúcar (r s=+0,419; p=0,001) e negativa com a duração do uso de chupeta (r s=-0,300; p=0,017).Conclusão:O uso da mamadeira e da chupeta estiveram relacionados a uma menor duração do aleitamento materno nestas comunidades.

Introduction: The average duration of breastfeeding is still insufficient and differ widely taking in account the location and specific characteristic of local people involved in these studies.Aim: This research aimed at studying factors associated to weaning among South Brazilian children living in a low-income household.Material and method: Cross-sectional study was carried out enrolling 124 mothers of 1 to 12-month-old children, who were interviewed at "Pastoral da Criança" (non-governmental organization) in Almirante Tamandaré, Paraná, Brazil. The risk of weaning considered was the dependent variable and the information collected from the questionnaires, independent variables. The method used to collect information in this study was Kaplan-Meier method and Cox regression model and Spearman's rank correlation (α = 0.05).Result: Actuarial life table presented a higher weaning conditional probability at 12 months of age, followed by first and fourth months of age. Multivariate analysis pointed out that contact with bottle feeding before the sixth month of age [HR=17.16 (2.34-125.86)] and contact with pacifier before the sixth months of age [HR=3.48 (1.90-6.38)] are risk factors associated with weaning. Among children who were not breastfed at the moment of the interview, breastfeeding duration presented a positive correlation with the ages when the children had their first contact with sugar (r s=+0.419, p=0.001) and negative correlation with the use of pacifier (r s=-0.300, p=0.017).Conclusion: Results from this study showed that the use of the feeding bottle and pacifier were related to a shorter breastfeeding time span at these communities.

The purpose of this study was to determine the survival and prognostic factors of patients with diffuse large B-cell lymphoma (DLBCL) of the oral cavity and maxillofacial region. Retrospectively, the clinical records of patients with a primary diagnosis of DLBCL of the oral cavity and maxillofacial region treated at the A.C. Camargo Hospital for Cancer, São Paulo, Brazil, between January 1980 and December 2005 were evaluated to determine (A) overall survival (OS) at 2 and 5 years and the individual survival percentage for each possible prognostic factor by means of the actuarial technique (also known as mortality tables), and the Kaplan Meier product limit method (which provided the survival value curves for each possible prognostic factor); (B) prognostic factors subject to univariate evaluation with the log-rank test (also known as Mantel-Cox), and multivariate analysis with Cox's regression model (all the variables together). The data were considered significant at p ≤ 0.05. From 1980 to 2005, 3513 new cases of lymphomas were treated, of which 151 (4.3%) occurred in the oral cavity and maxillofacial region. Of these 151 lesions, 48 were diffuse large B-cell lymphoma, with 64% for OS at 2 years and 45% for OS at 5 years. Of the variables studied as possible prognostic factors, multivariate analysis found the following variables have statistically significant values: age (p = 0.042), clinical stage (p = 0.007) and performance status (p = 0.031). These data suggest that patients have a higher risk of mortality if they are older, at a later clinical stage, and have a higher performance status.

RACIONAL: A recidiva tumoral após o transplante de fígado para o carcinoma hepatocelular tem grande impacto desfavorável na mortalidade e a presença de invasão microvascular desempenha papel importante na recidiva tumoral. OBJETIVO: Avaliar a sobrevida, o risco de recidiva tumoral pós-transplante e os fatores relacionados à invasão microvascular de uma série de transplantados por carcinoma hepatocelular. MÉTODOS: No período entre 1993 e 2007 foi estudada uma série consecutiva de 46 cirróticos com carcinoma hepatocelular submetidos à transplante de fígado baseado nos critérios de Milão a partir de 1996 ou critérios semelhantes no período anterior a esta data. Inicialmente todas as variáveis foram analisadas descritivamente, e as quantitativas através da observação dos valores mínimos e máximos, e do cálculo de médias e desvios-padrão e medianas. Para as variáveis qualitativas calcularam-se frequências absolutas e relativas. Realizou-se a regressão logística com ajuste pelo modelo de Cox para avaliar a sobrevida e os fatores relacionados à recidiva tumoral e invasão microvascular. RESULTADOS: A sobrevida da amostra foi de 64%, 59% e 45% para 1, 3 e 5 anos, respectivamente. Em 13% dos casos, a recidiva tumoral foi verificada. A análise multivariada identificou a chance de um paciente com nódulo bilobar sofrer invasão microvascular é 3,67 vezes maior em relação a um paciente com nódulo unilobar e a presença de um tumor unilobar representar um significativo efeito protetor em relação à invasão microvascular (p = 0,048). CONCLUSÕES: A identificação de um tumor bilobar no estadiamento tumoral é fator preditivo independente de maior risco de invasão microvascular e é necessário ainda confirmar se a presença de tumor bilobar deve ser adicionada aos critérios de Milão para melhor indicação de transplante de fígado em pacientes cirróticos com carcinoma hepatocelular.

BACKGROUND: An imprecise estimate of the tumor's aggressiveness of the hepatocellular carcinoma especially in transplanted patients beyond the Milan criteria has a poor outcome, although a more reliable criteria including microscopic vascular invasion is difficult to be established before transplantation. AIM: To examine a cohort of patients with hepatocellular carcinoma undergoing liver transplantation to evaluate the preoperative predicting factors for microscopic vascular invasion. METHODS: A series of 46 consecutive cirrhotic patients with hepatocellular carcinoma undergoing transplantation based on Milan criteria or similar criteria in a single center were enrolled between 1993 and 2007. The survival was calculated using Kaplan-Meyer's method and a multivariate Cox regression was performed to evaluate survival and factors related to microscopic vascular invasion. RESULTS: Multifocal tumors were present in 39%. Microvascular invasion, tumor relapses and hepatocellular carcinoma beyond the Milan criteria were identified in 33%, 13% and 33%, respectively. Overall 1-, 3-, and 5-year actuarial patient survival rates were 64%, 59% and 45% respectively. Patients who exceeded the Milan criteria had a higher incidence of microscopic vascular invasion and bilobar tumor compared to those who met the Milan criteria (53% vs. 23% and 80% vs. 19%; p<0.05, respectively). After multivariate analysis, the variable identified as independent risk factor for microscopic vascular invasion was the presence of bilobar tumor (hazard ratio, 3.67; 95% confidence interval, 1.01 to 13.34; p<0.05). CONCLUSIONS: The presence of a bilobar tumor is more frequent in hepatocellular carcinoma beyond the Milan criteria and it is an independent predictive factor of a high risk of microscopic vascular invasion. The presence of bilobar tumor in hepatocellular carcinoma beyond the Milan criteria could be used as selection criteria to estimate the risk of hepatocellular carcinoma recurrence, at least until large randomized studies becomes available.