RESUMEN La mortalidad causada por COVID-19 en México se ha situado entre las más altas del mundo, por lo que es de interés epidemiológico estudiar su impacto respecto a la esperanza de vida (EV). El objetivo del presente trabajo fue analizar el impacto de la pandemia por COVID-19 en la esperanza de vida, comparando datos de 2019 y 2020, y evaluando su efecto por densidad poblacional de los municipios de los estados del noreste de México. La información sobre mortalidad para 2019 y 2020 se obtuvo de la Secretaría de Salud, y la demográfica del Consejo Nacional de Población. Se construyeron tablas de vida mediante el método actuarial estándar; se calcularon percentiles ≤ 25 y ≥ 75 de la diferencia en la EV; se evaluó la relación entre el tamaño de la población de los municipios y la magnitud de la diferencia en la pérdida de años en la EV. La pandemia por COVID-19 impactó en la EV en los estados del noreste de México, con gran heterogeneidad al interior en cada uno de ellos. La pérdida en años en promedio fue, para Coahuila de 5.4, Nuevo León 4.1 y Tamaulipas 4.9. Los municipios del percentil ≥ 75 mostraron una pérdida promedio de 9.2 años y los del percentil ≤ 25 de -0.35 años. La diferencia en la pérdida en años de EV, entre 2019 y 2020, se vio influenciada por el tamaño de la población, tendiendo a ser mayor en aquellos con mayor densidad demográfica, sin ser el único factor determinante.

ABSTRACT COVID-19 mortality in Mexico is among the highest in the world. Therefore, it is of epidemiologic interest to study its impact on life expectancy. The aim of the present paper was to analyze the impact of the COVID-19 pandemic on life expectancy through a comparison of data from 2019 and 2020. Specifically, the effect of population density in municipalities of Northeastern Mexican states. Information regarding 2019 and 2020 mortality rates for was obtained from the Ministry of Health, and demographics from the National Population Council. Life tables were constructed using the standard actuarial method. Percentiles ≤ 25 and ≥ 75 of the difference in life expectancy in the period were calculated. The relationship between the size of the population of the municipalities and the magnitude of the difference in life expectancy loss of years was evaluated. COVID-19 pandemic impacted on life expectancy with great heterogeneity in each of the northeastern states of Mexico. The loss in years in average life expectancy was 5.4 for Coahuila, 4.1 for Nuevo Leon and 4.9 for Tamaulipas. Municipalities above the ≥ 75th percentile showed an average loss of 9.2 years. Those in the lower than ≤ 25th percentile showed a decrease, of -0.35 years. The difference in the loss of life expectancy during 2019 and 2020 was influenced by population size, tending to be greater in those municipalities with higher population density, but was not the only determining factor.

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 Contexto: seguradoras são importantes à sociedade, uma vez que garantem proteção financeira aos indivíduos contra perdas patrimoniais, além de fomentarem o mercado de capitais por meio da alocação de ativos garantidores. Assim, é fundamental avaliar os instrumentos que garantam sua solvência financeira de longo prazo. Dentre eles estão a adoção de tratados de resseguro, alocação de capital de solvência e modelagem atuarial dos processos de risco. Objetivo: estimar a probabilidade de ruína em processos de risco com a adoção de contratos de resseguro (quota-parte e excesso de danos), comparativamente a cenários sem tais tratados. Métodos: simulou-se o processo de Cramér-Lundberg via método de Monte Carlo, ajustando diversas distribuições probabilísticas à severidade do processo de Poisson composto, calibrando um conjunto de 3.917.863 microdados reais, segregados em 30 ramos securitários. Resultados: ainda que cada ramo apresente particularidades na severidade do sinistro, a correta escolha de resseguro (proporcional ou não) implica a redução da probabilidade de ruína para um capital de solvência fixo. Conclusão: a escolha adequada do contrato de resseguro, especialmente quando há evidências de elevada curtose nos valores de sinistros, intensifica o decaimento exponencial da relação entre o capital de solvência e a probabilidade de ruína.

ABSTRACT Context: insurance companies are important to society, since they guarantee financial protection to individuals from property losses, in addition to fostering the capital market through the allocation of guarantee assets. Thus, it is essential to evaluate the instruments that guarantee their long-term financial solvency. Among them are the adoption of reinsurance treaties, the sizing of the solvency capital, and the actuarial modeling of risk processes, which allow the measurement of the ruin probability. Objective: estimate the ruin probability in risk processes with the adoption of reinsurance contracts (quota share and excess of loss), compared to scenarios without such treaties. Methods: the Cramér-Lundberg process was simulated using the Monte Carlo method, adjusting several probabilistic distributions to the severity of the compound Poisson process, which is calibrated with a set of 3,917,863 real microdata, from 30 insurance lines of business. Results: it was found that, although each branch presents particularities in the claim severity, the correct choice of reinsurance (proportional or not) implies the reduction of the ruin probability for a fixed solvency capital. Conclusion: the appropriate choice of the reinsurance contract, especially when there is evidence of high kurtosis in the claim values, intensifies the exponential decline in the relationship between the solvency capital and the ruin probability.

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.

Abstract: Background: Aortic valve surgery can be performed through a reduced ministernotomy with less surgical trauma, improved cosmetics, faster recovery and excellent long-term results. Aim: To report the long-term results obtained with the minimally invasive approach technique in Southern Chile. Methods: A retrospective cohort study of 286 patients operated with the less invasive technique compared to 1161 patients operated on with full sternotomy for aortic valve replacement between 2004 and 2019 was performed. Arterial and venous cannulation was performed using small cannulas. Mean extracorporeal circulation flow was 4.5 L/min. Antegrade and retrograde cold cardioplegia was used. Statistical Analysis: Data are reported with measures of central tendency and dispersion. Categorical variables were compared with the X^2 test and ANOVA. Actuarial survival rate was calculated by Kaplan Meier method. The Stata 14 package was used for data analysis. Results: Demographic characteristics are shown in Table 1. Mean age of the whole cohort was 62.1 y/o (SD 6.4). There was no difference in 30 day mortality between groups. Incidence of arrhythmia, cerebral complications and AV block requiring pacemaker was similar between groups. There were no significant statistical differences in reoperation for bleeding, days of stay at the ICU and overall hospital stay. Mean follow up was 101 ± 4 (1169) months. After surgery most patients are in FC I and free from cardiac events and reoperation. In the postoperative period echocardiographic assessment was performed in 86% of patients showing similar hemodynamic function of the implanted valve. Actuarial survival rate was 97% and probability of freedom from cardiac events was 93% at 156 months of follow up. Conclusions: Ministernotomy is an excellent approach for aortic valve surgery which can be performed with very good results not inferior to those obtained with full sternotomy thus simplifying the surgical technique and reducing local hospital costs.

Resumen Introducción: La cirugía de la válvula aórtica puede ser efectuada a través de una esternotomía reducida con menos trauma quirúrgico, una recuperación más rápida, mejores resultados cosméticos y excelentes resultados a largo plazo. Objetivo: Comunicar los resultados a largo plazo obtenidos con el abordaje mínimamente invasivo en el Hospital Regional de Temuco. Material y Método: Estudio de cohorte retrospectivo de 286 pacientes operados con técnica mini invasiva comparados con 1161 pacientes operados a través de esternotomía completa para reemplazo valvular aórtico por enfermedad valvular entre 2004 y 2019. La edad promedio fue 62,1±6,4 años. Para la canulación arterial y venosa se utilizaron cánulas de tamaño pequeño. El flujo de circulación extracorpórea promedio fue 4.5 L/min. Se utilizó cardioplejia sanguínea infundida por vía anterógrada y retrograda. Se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Las variables categóricas fueron comparadas con el test de X^2 y las variables continuas con “t” test y ANOVA. La supervivencia actuarial se calculó mediante el método de Kaplan Meier con el programa Stata 14. Resultados: No hubo diferencia en la mortalidad a 30 días entre los grupos. Hallazgos similares se encontraron para arritmias, complicaciones cerebrales y bloqueo AV que requirió marcapasos. Hubo una diferencia estadísticamente significativa a favor del grupo de ministernotomía para reoperación por sangrado, días de estadía en UCI y estadía hospitalaria. El seguimiento promedio fue 101 ± 4 (1169 meses). La mayoría de los pacientes estaban en capacidad funcional I y libre de eventos cardiovasculares y reoperación. En el control post operatorio se hizo un ecocardiograma en el 86% de los pacientes mostrando buen resultado hemodinámico, similar en ambos grupos, y para distintas prótesis utilizadas. La probabilidad de sobrevida actuarial fue de 97% y la probabilidad de estar libre de eventos cardiovasculares fue 93% a 156 meses de seguimiento. Conclusión: La mini esternotomía es una técnica segura para la cirugía valvular aórtica con excelentes resultados en el largo plazo, permitiendo simplificar la cirugía, reducir los costos hospitalarios y permite una recuperación con menos secuelas cosméticas.

Resumen Objetivo: Analizar el abandono estudiantil en los programas de posgrado de una universidad privada de Colombia entre los años 2012 y 2016, con el fin de disponer de información que permita definir planes de mejoramiento enfocados en estrategias de permanencia. Metodología: Estudio cuantitativo, observacional, con aplicación de análisis de supervivencia. En el análisis descriptivo se calcularon frecuencias y proporciones para las variables cualitativas y para las variables cuantitativas medidas de tendencia central y de dispersión. La probabilidad de permanencia del estudiantado se calculó por medio del método Kaplan-Meier y se analizaron las funciones de supervivencia para cada nivel académico. La probabilidad de reingreso se calculó con el método actuarial. Resultados: El porcentaje de abandono fue del 5,7% y el de graduación del 72,0%. El abandono en especializaciones representó un 4,4%, en las maestrías un 8,5% y en los doctorados un 19,1%. La probabilidad de permanencia en las especializaciones fue del 94,1% al semestre 5, en las maestrías del 91,7% al semestre 4 y en los doctorados del 80,5% al semestre 3. La probabilidad de reingreso posterior a dos años de desvinculación fue del 0%. Conclusiones: La Universidad CES constantemente trabaja en pro de la permanencia, sin embargo, los resultados del presente estudio apoyarán la consolidación de los procesos de permanencia, atracción y graduación de las y los estudiantes.

Abstract Objective: Analyze the dropout scenario for graduate students at a private university in Colombia from 2012 to 2016 to attain sufficient data for enhancing strategies focused on keeping students in school. Methodology: A quantitative, observational study using survival analysis. Frequencies and proportions were calculated for the qualitative variables in the descriptive analysis. Quantitative variables were measured for overall trends and dispersion. Likelihood of student retention was calculated through the Kaplan-Meier method. Survival functions were analyzed for each academic level. Likelihood of return was calculated through an actuarial method. Results: The dropout rate was 5.7% whereas 72% of students graduated. Dropout in specializations were 4.4%, Master’s programs, 8.5% and Ph.D. programs, 19.1%. The likelihood of student retention in specializations was 94.1% by semester 5, 91.7% for the Master´s program by semester 4 and 80.5% for the Ph.D. program, by semester 3. The probability of the return beyond two years after a student dropped out was 0%. Conclusions: Although CES University strives to maintain the permanence of their students, the results of this study will be used to consolidate actions towards retaining students and encourage graduation.

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.

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.

Background: Even though the laparoscopic approach for rectal cancer has been previously described, its extended application is still controversial and the long-term oncological results are limited. Objective: To analyze the surgical results, local recurrence rate and 5-year survival in patients with rectal cancer operated on by laparoscopy. Secondarily, to compare the survival of patients operated on by laparoscopy with those who required conversion to open surgery. Setting: Private University Hospital Design: Retrospective observational. Material and Methods: One hundred and sixty four consecutive patients undergoing laparoscopic surgery for rectal cancer were analyzed between January 2005 and December 2011. The clinical, pathological and oncological data were collected into a database. Overall and disease free survival at 5 years was estimated by Kaplan-Meier method. Results: 66% of patients had tumors in middle (n=76) and low (n=32) rectum, and 26% (n=43) received neoadjuvant therapy. The sphincter preservation rate was 95%. The median distance between the anastomosis and the anal verge was 5 cm (range: 2 - 12), and a "j" pouch was performed in 8.5%. The overall conversion rate to open surgery was 14.6%. The morbidity and mortality was 19.5% and 0% respectively. The median hospital stay was 3 days (range: 2-28). Surgical margins were negative. The median of lymph nodes harvested was 15 (range: 0-56). According to TNM staging, there were 3.8% for stage 0, 37.8 for stage I, 22.5% for stage II, 29,2% for stage III and 6.7 for stage IV. The median follow up time was 25 months (range: 3-81). The overall local recurrence rate was 1.2% (two patients). The overall and disease free 5-year survival was 88% (IC 95%: 76-99) and 83% (IC 95%: 72-95) respectively. The overall 5-year survival of patients operated on by laparoscopy and those who required conversion to open surgery was 83.3% and 94%, respectively (p= NS). Conclusions: The laparoscopic approach for rectal cancer is safe. It does not affect the quality of the specimens and the oncological long-term outcomes. The 5-year overall survival of converted patients to open surgery is similar to the laparoscopic group.

Antecedentes: Si bien la factibilidad del tratamiento laparoscópico del cáncer de recto ha sido previamente descripta, su aplicación masiva continúa siendo controversial y los resultados oncológicos a largo plazo son aun limitados. Objetivo: Analizar los resultados peri operatorios, la tasa de recurrencia local y la sobrevida alejada a cinco años en pacientes con cáncer de recto operados por vía laparoscópica, y comparar la sobrevida de los pacientes operados por vía laparoscópica con la de aquellos que debieron ser convertidos. Diseño: Observacional retrospectivo Lugar de aplicación: Hospital Privado Universitario Método: Se analizaron 164 pacientes portadores de cáncer de recto operados por vía laparoscópica pura entre enero de 2005 y diciembre de 2011. Los datos clínicos, anatomopatológicos y oncológicos, fueron ingresados prospectivamente en una base de datos. La supervivencia global y libre de enfermedad a 5 años fue calculada según el método actuarial de Kaplan-Meier. Resultados: El 66% de la población presentó tumores de recto medio (n=76) e inferior (n=32), y el 26% (n= 43) recibió tratamiento neoadyuvante. La tasa de preservación esfinteriana fue del 95%. La mediana de la altura de la anastomosis fue de 5 cm (rango: 2 a 12), empleando un reservorio colónico en "J" en el 8,5%. El índice de conversión global fue del 14,6%. La morbilidad y mortalidad global fue 19,5% y 0% respectivamente. La mediana de estadía hospitalaria fue 3 días (r: 2-28). No se registró compromiso de los márgenes quirúrgicos. La media de ganglios linfáticos analizados fue de 15 (rango: 0 - 56). La distribución por estadíos de acuerdo al TNM fue del 3,8% para el estadío 0, 37,8% para el estadío I, 22,5% para el estadío II, 29,2% para el estadío III y 6,7% para el estadío IV. El seguimiento promedio fue de 25 meses (rango: 3 a 81). La tasa de recurrencia local de la serie fue del 1,2% (dos pacientes). La sobrevida global y libre de enfermedad a cinco años fue del 88% (IC 95%: 76-99) y 83% (IC 95%: 72-95) respectivamente. La sobrevida global a 5 años de los pacientes convertidos versus lo no convertidos, fue del 83,3% y 94% respectivamente (p= NS). Conclusiones: El tratamiento laparoscópico del cáncer de recto es oncologicamente seguro. No ha afectado la calidad de las piezas quirúrgicas obtenidas ni los resultados oncológicos a largo plazo. La sobrevida global de los pacientes convertidos resultó equivalente a la de los operados en forma laparoscópica.