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.

ABSTRACT As transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) became widespread, the need for a Heart Team (HT) arose to choose the best treatment. There are few reports regarding its usefulness. Objectives: To analyze treatment outcomes in patients with AS evaluated by a HT for 10 years. Methods: Consecutive enrollment of all patients with AS who were candidates for TAVI between January 2012 and July 2021 to choose the best treatment, including surgical aortic valve replacement (SAVR) and conservative medical management (CMM). Results: Out of 841 patients, 455 were assigned to TAVI (53%), 213 to SAVR (24%), and 183 to CMM (23%). The percentage assigned to TAVI has increased from 48% to 62% over time (p <0.05). Patients who underwent TAVI versus those who underwent SAVR were older (86 ± 7 vs. 83 ± 7 years), had a higher EUROSCORE II (6.2, 95% CI 5.7-6.6 vs. 5.6; 95% CI 4.4-6.5) and were frailer (1.62 ± 1 vs. 0.91 ± 1), in all cases p <0.01. Actuarial survival (95% CI) at 1 and 2 years was 88% (84-91%) and 82% (77-86%) for TAVI, 83% (76-88%) and 78% (70-84%) for SAVR, and 70% (60-87%) and 59% (48-68%) for CMM, respectively (p <0.001). Conclusions: For the first 10 years after a Heart Team was established for AS decision-making, approximately half of the patients were assigned to TAVI, and the rest were equally assigned in halves to either surgery or observation. Survival for patients who received interventions was similar at 2 years and higher than in those who did not.

RESUMEN La difusión del reemplazo valvular aórtico percutáneo (TAVI) en la estenosis aórtica (EAo) generó la creación de un Heart Team (HT), para elegir el mejor tratamiento. Existen pocos reportes sobre su utilidad. Objetivos: analizar los resultados del tratamiento de los pacientes con EAo evaluados por un HT durante 10 años Material y métodos: Inclusión consecutiva de todos los pacientes con EAo candidatos a TAVI entre enero del 2012 y julio del 2021 para seleccionar el mejor tratamiento, incluyendo además Cirugía de reemplazo valvular aórtico (CRVA) y Tratamiento médico conservador (TMC). Resultados: De 841 pacientes, se asignaron a TAVI 455 (53%), CRVA 213 (24%) y TMC 183 (23%). El porcentaje asignado a TAVI aumentó con el tiempo de 48 a 62% (p < 0,05). Los pacientes que fueron a TAVI, con respecto a los enviados a CRVA, eran mayores (86 ± 7 vs 83 ± 7 años), con mayor EUROSCORE II (6,2, IC95% 5,7-6,6 vs 5,6, IC95% 4,4-6,5) y más frágiles (1,62 ± 1 vs 0,91 ± 1), en todos los casos p <0,01. La sobrevida actuarial (IC 95%) a 1 y a 2 años fue, para TAVI 88% (84-91%) y 82% (77-86%), para CRVA 83% (76-88%) y 78% (70-84%) y para TMC 70% (60-87%) y 59% (48-68%) respectivamente (p <0,001). Conclusiones: Durante los primeros 10 años de establecido un Heart Team para la toma de decisiones en EAo, se asignaron a TAVI aproximadamente la mitad y el resto se asignó por mitades a cirugía u observación. La sobrevida de los pacientes intervenidos fue similar a 2 años y mayor que la de los no intervenidos.

Resumen Ante la escasez de investigaciones que atiendan el impacto de la privatización del sistema penitenciario en América Latina, tomamos el caso mexicano con el objetivo de problematizar la implantación del outsourcing penitenciario y la acreditación de los nuevos penales a cargo de la Asociación de Correccionales de América (ACA). En su contextualización histórica, veremos cómo la privatización de las prisiones y la expansión de la precarización y el encarcelamiento como forma de gobierno se localizan a partir de la firma del Plan Mérida, en medio del fuego cruzado de la guerra declarada contra el narcotráfico; la rúbrica traerá un impulso neoliberalizador con el que desembarcará el modelo del outsourcing penitenciario. Con base en la metodología de las narrativas situadas problematizamos, junto con una trabajadora penitenciaria, las condiciones subjetivantes que movilizarían el outsourcing penitenciario en empleados y empleadas de nuevo ingreso en este tipo de penales. También analizamos los pormenores del régimen de actividad laboral al que los estándares de la ACA les conminan. Concluimos que el outsourcing penitenciario plantea un horizonte laboral de precarización en el cual se exige a quien lo integra que desarrolle progresivamente una caja de herramientas técnicas multiusos; esta suerte de trabajador o trabajadora politécnica deberá también sujetarse al régimen de actividad de la ACA y a la sensibilidad punitiva del modelo actuarial.

Abstract Given the scarcity of research on the impact of the privatization of the prison system in Latin America, we take the Mexican case with the aim of problematizing the implementation of prison outsourcing and the accreditation of new prisons by the American Correctional Association (ACA). In historical context, we will see how the privatization of prisons and the expansion of precariousness and incarceration as a form of government began with the signing of the Merida Plan, amidst the crossfire of the war declared against drug trafficking, which brought the neoliberalizing impulse with which the prison outsourcing model would begin. Based on the methodology of situated narratives, we problematized, together with a prison worker, the subjectivizing conditions that would mobilize prison outsourcing among new employees in this type of prisons. We also analyzed the details of the labor activity regime that the ACA standards require of them. We conclude that prison outsourcing poses a labor horizon of precariousness in which those who integrate it are required to progressively develop a multipurpose technical toolbox; this kind of polytechnical worker must also be subject to the activity regime of the ACA and to the punitive sensitivity of the actuarial model.

This paper analyzes, from the perspective of the desirable properties of interest rate curves, the adequacy of the Term Structures of Interest Rates established by Susep for the purpose of actuarial liabilities evaluation and measurement of the additional capital requirement based on market risk. In order to analyze the fit of the curves in relation to the observed data, estimation errors, their descriptive statistics and the mean of the mean squared errors were calculated. To analyze estimated rates volatility, maturities of interest were defined and the standard deviation was calculated for each one over the period of analysis. The results indicate that, in general, the established curves present satisfactory fit to the points observed in the market. However, there is evidence that the long-term rates estimated by Susep’s curves present higher volatility than those for observed long-term rates, which shall be a relevant issue for practical matters. Lastly, Susep’s prefixed and IPCA coupon curves were compared to Anbima’s and the latter seem to be more effective, which justifies Susep’s decision on abort generating some of its curves.

Este trabajo analiza, desde la perspectiva de las propiedades deseables de las curvas de interés, la adecuación a la realidad brasileña de las Estructuras de Plazos de Tasas de Interés (ETTJ) fijadas por Susep con el fin de evaluar los pasivos actuariales y determinar el requerimiento de capital adicional basado en el riesgo de mercado. Para analizar la adherencia de las curvas a los datos observados, se calcularon los errores de estimación, sus estadísticas descriptivas y la media de los errores cuadrados medios. Para analizar la volatilidad de las tasas estimadas, se definieron los términos de interés y se determinó la desviación estándar para cada término durante el período de análisis. Los resultados encontrados indican que las curvas fijas tienen, en general, una adherencia satisfactoria a los puntos observados en el mercado. Sin embargo, existe evidencia de que las tasas a largo plazo estimadas por las curvas construidas por Susep tienen mayor volatilidad que las tasas a largo plazo observadas, lo cual se configura como un tema práctico relevante. Finalmente, las curvas prefijadas y cupones de IPCA de Susep se compararon con las de Anbima y estas últimas demostraran ser más efectivas, justificando la decisión de Susep de extinguir la generación algunas de sus curvas.

Resumo Este trabalho analisa, sob a ótica das propriedades desejáveis das curvas de juros, a adequação à realidade brasileira das Estruturas a Termo das Taxas de Juros fixadas pela Susep para fins de avaliação dos passivos atuariais e de determinação do requerimento de capital adicional baseado no risco de mercado. Com o intuito de analisar a aderência das curvas aos dados observados, foram calculados os erros de estimação, suas estatísticas descritivas e a média dos erros quadráticos médios. Para analisar a volatilidade das taxas estimadas, definiram-se prazos de interesse e apurou-se, para cada prazo, o desvio-padrão ao longo do período de análise. Os resultados encontrados indicam que as curvas fixadas apresentam, em geral, aderência satisfatória aos pontos observados no mercado. Não obstante, há evidências de que as taxas de longo prazo estimadas pelas curvas construídas pela Susep possuem volatilidade mais elevada do que a verificada para as taxas de longo prazo observadas, o que se configura uma questão relevante de ordem prática. Por fim, as curvas prefixada e cupom de IPCA da Susep foram comparadas às da Anbima e estas últimas se mostraram mais eficazes, justificando a decisão da Susep de parar de gerar algumas de suas curvas.

Big data is changing the way many companies conduct business on a day-to-day basis. Insurers are notorious for utilising data in the risk assessment of prospective and current policyholders. The use of such risk assessment mechanisms in insurance has resulted in some discrimination between various policyholders but this has been held to be justifiable due to the fact that it is based on actuarial science and is therefore viewed as fair. However, the advent of big data, data analytics, algorithms, and artificial intelligence is providing insurers with far more sophisticated data about potential policyholders. This may prove to be beneficial to insurers in many ways, but it also brings about additional possibilities of exclusion within the industry. This use of big data has the potential to increase social injustices within our country, which is something that needs to be avoided as much as possible. Discrimination, through the use of big data, is a reality that needs to be addressed by insurers and regulators alike. Achieving social justice as far as possible in the insurance industry is crucial and also requires considerations in the areas of morality and ethics. The reason for this is that the very nature of big data is integrally linked to the assessment of the policyholder's moral risks and hazards for the benefit of the insurer is often linked to personal circumstances and, sometimes, the financial circumstances of the policyholder, and may even speak to the policyholder's integrity. Although potentially beneficial for the insurers from a risk assessment perspective, the use of big data has ethical and moral considerations within the insurance context. After all, the insurance industry's collection, storage, and use of big data raises ethical and moral concerns and casts a shadow on the manner it is used to assess policyholders. This discussion highlights the need for regulatory oversight of big data, an aspect that is notably missing in the South African legislative framework.

Abstract Background Endovascular treatments for thoracic aortic diseases have been adopted rapidly, and long-term studies are relevant for durability evaluation. Objective To evaluate the long-term results of a prospective observational study of endovascular treatment in patients with thoracic aortic diseases who underwent percutaneous implantation of self-expandable endoprostheses. Methods Procedural success was defined as the absence of endoleak into the aneurysm or dissection-induced false lumen, no migration, and no conversion to open surgery. Intraoperative, postoperative, and late postoperative outcomes were evaluated in terms of complications, mortality, and evolution of the endoprosthesis over a follow-up of up to 179 months (median: 46 months). Results A total of 150 endoprostheses were implanted in 112 patients. Primary success was observed in 100 (82.14%) patients. Immediate mortality occurred in 7 patients (6.25%). Late mortality occurred in 31 patients (27.68%), 10 (8.93%) of whom died from cardiovascular causes, 12 (10.71%) from non-cardiovascular causes, and 2 (1.78%) from natural causes, while 7 (6.25%) had no diagnosis for cause of death. Types I, II, and IV endoleaks occurred during hospitalization in 4 (3.57%), 5 (4.46%), and 3 (2.68%) patients, respectively. Late types I and IV endoleaks occurred in 5 (4.46%) and 3 (2.68%) patients respectively. Twenty-two patients (19.64%) had clinical complications in the immediate postoperative period. Actuarial survival free from death from cardiovascular causes was 79.3% (95% confidence interval, 67.0-91.7%) at 132 months. Conclusions The low levels of intraoperative and postoperative complications demonstrate that endovascular treatment is safe and effective. The high rate of late survival for these critically ill patients indicates that the endovascular technique is beneficial for treatment of thoracic aortic diseases in terms of long-term outcomes.

Resumo Contexto Os tratamentos endovasculares para doenças da aorta torácica têm sido adotados rapidamente e estudos de longo prazo são relevantes para avaliação de durabilidade. Objetivo Avaliar através de estudo observacional e prospectivo, os resultados a longo prazo do tratamento endovascular em pacientes com doenças da aorta torácica submetidos a implante percutâneo de endoprótese autoexpansível. Métodos O sucesso do procedimento foi definido como ausência de vazamento interno para o aneurisma ou falso lúmen induzido por dissecção, ausência de migração e sem necessidade de conversão para cirurgia aberta. Os resultados intraoperatórios, pós-operatórios e tardios foram avaliados quanto a complicações, mortalidade e evolução da endoprótese em um seguimento de até 179 meses (mediana de 46 meses). Resultados Um total de 150 endopróteses foram implantadas em 112 pacientes. Sucesso primário foi observado em 100 (82,14%) pacientes. Mortalidade imediata ocorreu em sete pacientes (6,25%). A mortalidade tardia ocorreu em 31 pacientes (27,68%), dos quais 10 (8,93%) morreram por causas cardiovasculares; 12 (10,71%), por causas não cardiovasculares; dois (1,78%), por causas naturais e sete (6,25%) não tiveram a causa da morte diagnosticada. Vazamentos tipo I, II e IV ocorreram durante a internação em quatro (3,57%), cinco (4,46%) e três (2,68%) pacientes, respectivamente. Vazamentos tardios tipo I e IV ocorreram em cinco (4,46%) e três (2,68%) pacientes, respectivamente. Complicações clínicas no pós-operatório imediato foram observadas em 19,64% dos pacientes. A sobrevida atuarial por causas cardiovasculares foi de 79,3% em 132 meses. Conclusões Os baixos índices de complicações intra e pós-operatórias demonstram que o tratamento endovascular é seguro e eficaz. A alta taxa de sobrevida em 132 meses em pacientes críticos indica que a técnica é benéfica para o tratamento de doenças da aorta torácica em resultados a longo prazo.

Abstract This article presents the Brazilian private insurance market’s actuarial life tables, BR- EMS 2021. Using Bayesian inference on the parameters of the Heligman- Pollard law of mortality and data from 23 insurance groups over 15 years, totaling 3.5 billion registers, the data were corrected through a two hidden-layer neural network. The resulting tables show that the insured population exhibits lower mortality rates than the general Brazilian population, even lower than the national populations of well-developed countries such as the USA. Moreover, besides the expected gender gap in mortality rates, there is a clear distance between the death and survivorship insurance coverage groups. Likewise, the insured population characteristics mitigate well-known regional structural discrepancies in the Brazilian population, indicating that being part of the selected population of insured individuals is thus associated with a more effective protection against death than other outstanding factors such as geographic region of residence.

Resumen Este artículo presenta las tablas de vida del mercado de seguros privados brasileño, BR-EMS 2021. Los datos, obtenidos de 23 grupos de seguros a lo largo de 15 años, totalizando 3,5 mil millones de registros, fueron corregidos usando una red neuronal con dos capas ocultas. Mediante la inferencia bayesiana para estimar los parámetros bajo la ley de mortalidad de Heligman-Pollard, las tablas obtenidas muestran que la población asegurada tiene tasas de mortalidad más bajas que la población general brasileña e incluso más bajas que las poblaciones nacionales de países desarrollados, como los Estados Unidos de Norteamérica. Además de la diferencia de género esperada en las tasas de mortalidad, hay una clara distinción entre las tablas de grupos de cobertura de riesgo y cobertura de sobrevivientes. Asimismo, se demuestra que las tablas regionales de población asegurada no presentan las conocidas discrepancias estructurales regionales en Brasil, lo que indica que participar de la población de asegurados está asociado con una protección contra la muerte más efectiva que otros factores como la región geográfica de residencia.

Resumo Este artigo apresenta as tábuas de vida do mercado de seguros privados brasileiro, BR-EMS 2021. Os dados obtidos de 23 grupos seguradores ao longo de 15 anos, totalizando 3,5 bilhões de registros, foram corrigidos por meio de rede neural com duas camadas ocultas. Usando a inferência bayesiana para estimar os parâmetros sob a lei de mortalidade Heligman-Pollard, as tábuas obtidas mostram que a população segurada apresenta probabilidades de morte mais baixas do que a população brasileira em geral e até mesmo em relação a populações nacionais de países desenvolvidos, como os EUA. Além da esperada diferença de gênero nas taxas de mortalidade, há uma clara distância entre as probabilidades de morte dos grupos de cobertura de risco e cobertura de sobrevivência. Da mesma forma, é demonstrado que as tábuas regionais da população segurada não apresentam as discrepâncias regionais conhecidas no Brasil, indicando que fazer parte da população selecionada de segurados está associado a um fator de proteção mais eficaz do que outros fatores, como a região geográfica de residência.

Resumen Introducción: las amputaciones mayores han disminuido en los últimos años, hasta aproximadamente el 7 % de los pacientes con enfermedad arterial periférica crónica (EAPC). La protetización es un procedimiento complejo e importante para la calidad de vida de los pacientes. Las series publicadas comunican datos muy variables entre ellas. Objetivo: describir la evolución de los pacientes sometidos a una amputación mayor por EAPC en nuestro centro y su protetización en relación a su estado basal. Materiales y métodos: estudio descriptivo, retrospectivo y unicéntrico. Recogimos las amputaciones mayores realizadas por nuestro servicio entre 2013 y 2019. Realizamos una búsqueda del registro de pacientes protetizados. Se recogieron las variables sociodemográficas, clínicas, de la intervención, del posoperatorio y de la rehabilitación. Analizamos las variables cualitativas en forma de frecuencias absolutas y porcentajes, los datos cuantitativos mediante la media, la inferencia estadística con el χ2 y la supervivencia con análisis actuarial. Resultados: realizamos 282 amputaciones mayores, de las que el 65,95 % fue en hombres, con una edad media de 71,23 años. El 82,68 % fueron supracondíleas y el 17,32 %, infracondíleas. El 30,85 % tuvieron una amputación menor previa. El 51,06 % habían sido revascularizados previamente. Solo el 37,9 % contaba con una red social adecuada de apoyo. La mediana de supervivencia fue de 24 meses. La mortalidad al año fue del 35 %. El 29,32 % de los pacientes tenía una marcha independiente previa, el 21,22 % no deambulaba y el resto requería ayuda para la marcha. El 28 % (79) de los pacientes fue protetizado, con un uso medio de la prótesis de 15,34 horas al día. El estado de marcha previa se relacionó de manera significativa con la protetización, que consiguió el 49,9 % de los que tenían una marcha independiente frente al 1,69 % de los que no deambulaban (p < 0,001). Del resto de factores analizados tenían una relación estadísticamente significativa con la protetización los siguientes: sexo masculino (p < 0,028), menores de 70 años (p < 0,001), red social adecuada de apoyo (p < 0,001), antecedente de revascularización previa (p < 0,001) y nivel de amputación infracondílea (p < 0,001). Conclusiones: el porcentaje de protetización de los pacientes sometidos a una amputación mayor es bajo y está relacionado con el estado de deambulación previa, el género, la edad, la red social de apoyo y el nivel de amputación.

Abstract Introduction: a decrease in rate of mayor amputation has been reported over the last years; approximately 7 % of patients with chronic peripheral arterial disease (PAD). Implant a prosthesis is a complex and important procedure for the patients´ quality of life. The journals shown different data between them. Objective: to describe the evolution of patients undergoing a major amputation due to PAD in our center and their prosthesis procedure in relation to their baseline status. Materials and methods: descriptive, retrospective and single center study. We collected all major amputations performed by our department between 2013 to 2019. We searched the registry of patients with prosthesis. Sociodemographic, clinical, intervention, postoperative and rehabilitation variables were collected. We analyzed the qualitative variables in the form of absolute frequencies and percentages, the quantitative data through the mean, the statistical inference with the chi2 and the survival with actuarial analysis. Results: we performed 282 major amputations, 65.95 % in men, with a mean age of 71.23 years. 82.68 % were above the knee and 17.32 % below the knee. 30.85 % had a previous minor amputation. 51.06 % had been previously revascularized. Only 37.9 % had an adequate social support. Median survival was 24 months. Mortality at one year was 35 %. 29.32 % of the patients had a previous independent walk, 21.22 % did not walk and the rest required assistance for walking. 28 % (79) of the patients received a prosthesis, with an average use of the prosthesis of 15.34 hours per day. Previous gait status was significantly related to wearing prosthesis, achieved by 49.9 % of those who walked independently versus 1.69 % of those who did not walk (p < 0.001). Of the rest of the factors analyzed, the following had a statistically significant relationship with prosthetic fitting: male gender (p < 0.028), younger than 70 years (p < 0.001), adequate social support (p < 0.001), history of previous revascularization (p < 0.001) and level of amputation (below the knee) (p < 0.001). Conclusions: the percentage of prosthetics of patients undergoing a major amputation is low and is related to the state of previous ambulation, gender, age, social support and level of amputation.

Resumo O objetivo é avaliar o peso do pagamento de sinistros fraudulentos do seguro DPVAT pela seguradora Líder, consórcio de seguradoras privadas que administram o produto. Utilizando a Teoria da Credibilidade Atuarial em dados oficiais, analisou-se a discrepância das sinistralidades do DPVAT relativamente aos diferentes seguros privados de automóveis, proxies da formação ideal de prêmios, por possuírem melhores sistemas de controle e prevenção de fraudes. Os resultados apontaram diferenças significantes entre os valores. Adicionalmente, em dois cenários contrafactuais estimou-se: (i) qual seria o prêmio do DPVAT caso fossem expurgados os efeitos das fraudes, de modo a avaliar se a heterogeneidade verificada poderia ser explicada pelo volume de fraudes comprovadas; (ii) o potencial volume financeiro economizado pela sociedade caso as fraudes tivessem sido expurgadas desde 2006. É possível afirmar que não apenas a sinistralidade do produto teria sido reduzida, como também o preço repassado aos segurados. Finalmente, as estimativas apontam que a sociedade teria economizado mais de R$15 bilhões em 14 anos.

Abstract The goal of this paper is to assess the weight of fraudulent claim payments of DPVAT insurance by the insurer Líder, a consortium of private insurers who manage this product. Using the Actuarial Credibility Theory, and a official database, the discrepancy between the DPVAT claims ratio and the claims ratios of other private automobile insurance lines of business, proxies for the ideal premium formation for having better system of frauds detection and prevention. The results indicate significant differences among the values. Additionally, in two counterfactual scenarios, it was estimated: (i) what would be the value of the DPVAT premium in case the fraud effects were purged, aiming to analyze whether the verified heterogeneity could be explained by the volume of proven frauds; (ii) the financial volume that could potentially be saved by society in case the frauds were subtracted since 2006. It is possible to affirm that not only would the DPVAT’s claims ratio be reduced, but also the premiums paid by the insured. Finally, the estimates suggest that society could have saved over BRL 15 billion in 14 years.

ABSTRACT Introduction: There is no complete consensus on the three surgical methods and long-term consequences for coexisting coronary and carotid artery disease. We retrospectively evaluated the surgical results in this high-risk group in our clinic for a decade. Methods: Between 2005 and 2015, 196 patients were treated for combined carotid and coronary artery disease. A total of 50 patients were operated on with the staged method, 40 of which had carotid endarterectomy (CEA) priority, and 10 had coronary artery bypass grafting (CABG) priority. CABG and CEA were simultaneously performed in 82 patients; and in 64 asymptomatic patients with unilateral carotid artery lesions and stenosis over 70%, only CABG was done (64 patients). Results were evaluated by uni-/multivariate analyses for perioperative, early, and late postoperative data. Results: In the staged group, interval between the operations was 2.82±0.74 months. Perioperative and early postoperative (30 days) parameters did not differ between groups (P-value < 0.05). Postoperative follow-up time was averaged 94.9±38.3 months. Postoperative events were examined in three groups as (A) deaths (all cause), (B) cardiovascular events (non-fatal myocardial infarction, recurrent angina, congestive heart failure, palpitation), and (C) fatal neurological events (amaurosis fugax, transient ischemic attack, and stroke). When group C events were excluded, event-free actuarial survival rates were similar in all three methods (P=0.740). Actuarial survival rate was significantly different when all events were included (P=0.027). Neurological events increased markedly between months 34 and 66 (P=0.004). Conclusion: Perioperative and early postoperative event-free survival rates were similar in all three methods. By the beginning of the 34th month, the only CABG group has been negatively separated due to neurological events. In the choice of methodology, “most threatened organ priority’’ was considered as clinical parameter.

Resumo O modelo brasileiro de Saúde Suplementar, baseado na Repartição Simples, reflete dificuldade de permanência do indivíduo com o avanço da idade, que traz expressivo acréscimo na contraprestação dos planos e o eventual fim da relação empregatícia. Com o objetivo de avaliar um modelo alternativo na manutenção saudável dos planos de saúde, foi estudada a viabilidade de um produto baseado na acumulação de recursos ao longo da vida. Foram realizadas simulações variando premissas impactantes no valor necessário a contribuir em relação ao salário, sendo utilizados dados da ANS. Os resultados sugerem que um modelo de plano de saúde por acumulação pode ser viável, dependendo do cenário em que o indivíduo se encontra, apresentando-se mais acessível a indivíduos do sexo masculino, residentes na região sudeste, que iniciem suas contribuições ao plano cedo, aposentem-se mais tarde e se encontrem em uma economia que apresente taxas de juros altas e taxas de reajuste baixas.

Abstract The Brazilian model of Private Health, based on Pooling Risk, reflects difficulty of permanence to the beneficiary as the age increases, given that there is a significant increase in the costs and the eventual end of the employment relationship. In order to evaluate alternative model for the healthy maintenance of health insurances, the feasibility of a plan based on accumulation of resources throughout life was studied. Simulations were performed varying assumptions that impact the amount necessary to contribute in relation to the salary, using data from ANS. The results suggest that a health insurance model by accumulation can be feasible, depending on the scenario in which the individual finds himself, presenting itself with easier access to male individuals, residing in the Southeast Region, who start their contributions to the plan early, retire later and are in an economic scenario with high interest rates and low readjustment fee.

RESUMO O objetivo do artigo foi avaliar a viabilidade do Universal Life (UL) no Brasil sob duas perspectivas: do ponto de vista individual dos contratantes, considerando diferentes perfis de clientes e cenários de investimento; e sob a ótica empresarial, verificando se as seguradoras enxergam no UL vantagens de comercialização. Assim, apesar da indefinição da regulamentação dos contratos pela Superintendência de Seguros Privados (Susep), a contribuição deste artigo é avaliar o UL - produto tipicamente americano - no Brasil, utilizando metodologia integralmente atuarial, para segurados e seguradoras, em função de parâmetros locais. A relevância do artigo está no fornecimento de subsídios para indivíduos, empresas e autoridades avaliarem o produto e discutirem sua implementação, identificando, até mesmo, os perfis e cenários mais favoráveis ao seu desenvolvimento. Embora o UL seja uma modalidade de seguro individual muito difundida em diversos países e seu desenho explorar atrativos bem-definidos, o produto não havia sido explorado pela literatura nacional. A metodologia adotada no presente estudo usou modelagem inteiramente atuarial, taxa interna de retorno (TIR) e profit testing. O trabalho revela que o mercado brasileiro para o UL é viável, sobretudo em função das taxas de juros mais elevadas se comparadas aos países onde o produto já é amplamente disseminado. Sob a perspectiva da demanda, os resultados apontam que o segurado estaria em situação mais vantajosa adquirindo o UL do que comprando um seguro de vida no mercado privado e investindo o excedente em aplicações financeiras, devido à característica híbrida do contrato, que possibilita a utilização dos rendimentos financeiros como fatores de desconto na parcela securitária e nos encargos da operação, reduzindo os custos de oportunidade atrelados ao produto. No que tange às empresas, os resultados do profit testing sugerem haver estímulos para a oferta do UL, desde que a operação tenha viés de longo prazo. Alterando-se o padrão de mortalidade, tipo de apólice e perfil de investimento da companhia, todos os resultados apontam para direção similar.

ABSTRACT The aim of this article was to evaluate the viability of Universal Life insurance (UL) in Brazil from two perspectives: from the individual viewpoint of policyholders, considering different client profiles and investment scenarios; and from the company viewpoint, verifying whether insurers see sales advantages in UL. Thus, despite the lack of definition of the regulations on these contracts by the Superintendence of Private Insurance (Susep), this article’s contribution lies in evaluating UL - a typically American product - in Brazil, using an entirely actuarial methodology, for policyholders and insurers, according to local parameters. The relevance of the article lies in strengthening the support for individuals, companies, and authorities to evaluate the product and discuss its implementation, even identifying the most favorable profiles and scenarios for its development. Although the UL is an individual modality that is widespread in several countries and its design exploits well-defined attractions, the product has not been explored in the national literature. The methodology adoted in this study used fully actuarial modeling, the internal rate of return (IRR), and profit testing. The study reveals that the Brazilian market for UL is viable, especially due to the higher interest rates compared to countries where the product is already widespread. From a demand perspective, the results indicate that the policyholder would be in a more advantageous position acquiring UL than buying life insurance in the private market and investing the surplus in financial assets, due to the hybrid characteristic of the contract, which enables the use of financial returns as discount factors in the insurance portion and operational charges, reducing the opportunity costs linked to the product. With regard to companies, the profit testing results suggest there are stimuli for the supply of UL, provided the operation has a long-term bias. Altering the mortality pattern, policy type, and the company’s investment profile, all the results point in a similar direction.

RESUMEN Introducción: La cirugía de revascularización miocárdica (CRM) ha modificado la evolución natural de los pacientes con enfermedad de tronco de la arteria coronaria izquierda (TCI). En nuestro medio es escasa la información relacionada con el seguimiento a mediano y largo plazo de los pacientes intervenidos. Objetivo: Evaluar la implicancia de la enfermedad del TCI en la evolución alejada de los pacientes intervenidos con CRM, y conocer la mortalidad e incidencia de infarto de miocardio (IAM) y/o accidente cerebrovascular (ACV). Resultados: El seguimiento se completó en 438 pacientes (95,6%) con una mediana de 58 meses [Rango intercuartilo (RIC) 35-88 meses]. La sobrevida actuarial fue a 10 años del 91,8% para toda la población, sin diferencias significativas entre el grupo TCI (91,57%) vs. el grupo no TCI (91,86%), HR 1,008, IC95% 0,38-2,65, p=0,98. En el análisis multivariado se encontraron como predictores de mortalidad alejada la fracción de eyección ventricular izquierda preoperatoria (HR 0,95, IC 95% 0,93-0,97, p<0,001), la edad (HR 1,1, IC 95% 1,04-1,13, p< 0,001) y la prioridad no electiva de la cirugía (HR = 3,71; IC 95%: 1,3-10,35; p = 0,01). La sobrevida libre de IAM fue del 96,8% (TCI 94% vs. no TCI 97,4%, p= 0,8) y la libertad de ACV fue del 98% (TCI 97,8% vs. no TCI 98,1%, p= 0,8). Conclusión: En los pacientes sometidos a CRM, la presencia de enfermedad del TCI no incrementó la tasa de eventos duros (muerte, IAM y ACV) en el seguimiento alejado. Los resultados obtenidos en esta serie de pacientes son similares a los publicados en la bibliografía internacional utilizada para desarrollar las guías de revascularización miocárdica.

ABSTRACT Background: Coronary artery bypass grafting (CABG) has modified the natural evolution of patients with left main coronary artery (LMCA) disease. There is little information in our setting regarding the mid- and long-term follow-up of operated patients. Objective: The aim of this study was to evaluate the implication of LMCA disease in the long-term evolution of patients operated on with CABG, and to assess the mortality and incidence of myocardial infarction (AMI) and/or stroke. Results: Follow-up was completed in 438 patients (95.6%) with a median of 58 months [interquartile range (IQR) 35-88 months]. Actuarial survival at 10 years was 91.8% for the entire population, with no significant differences between the LMCA group (91.57%) vs. the non-LMCA group (91.86%), HR 1,008 95% CI 0.38-2.65, p=0.98. In multivariate analysis, preoperative left ventricular ejection fraction (HR = 0.95; 95% CI 0.93-0.97; p < 0.001), age (HR 1.1, 95% CI 1.04-1.13, p<0.001) and non-elective priority of surgery (HR=3.71; 95% CI 1.3-10.35; p=0.01) were independent predictors of long-term mortality. AMI-free survival was 96.8% (LMCA 94% vs. non-LMCA 97.4%, p=0.8) and freedom from stroke was 98% (LMCA 97.8% vs. non-LMCA 98.1 %, p=0.8). Conclusion: In patients undergoing CABG, the presence of LMCA disease did not increase the rate of hard events (death, AMI, and stroke) at the long-term follow-up. The results obtained in this series of patients are similar to those published in the international literature used to develop myocardial revascularization guidelines.

ABSTRACT Introduction: Pediatric heart transplantation is the definitive therapy for children with end-stage heart failure. This paper describes our initial experience in pediatric heart transplantation in a tertiary center in Brazil Methods: This is a historical prospective descriptive cohort study based on a review of the medical records of children undergoing heart transplantation at Hospital de Base and Hospital da Criança e Maternidade de São José do Rio Preto. Variables were displayed as frequency, mean, or median. Statistical analysis and Kaplan-Meier actuarial curve were obtained with the aid of Microsoft® Excel® 2019 and STATSDirect version 3.3.5. Results: Between January 2010 and December 2020, ten children underwent bicaval orthotopic heart transplantation, 30% of which were under one year of age. Nine patients had end-stage heart failure (International Society for Heart and Lung Transplantation-Heart Failure D) and 50% of the recipients were transplanted under conditions of progressive clinical deterioration (Interagency Registry for Mechanically Assisted Circulatory Support ≤ 2). Forty percent of the recipients had a panel-reactive antibody > 20% on virtual crossmatch. In the postoperative period, 80% of patients required high dose of inotropic support (vasoactive-inotropic score > 10) for > 48 hours. The death-free survival rate at 131 months was 77.1±14.4%. Most patients (88.9%) in late follow-up had an episode of active cytomegalovirus infection. Cellular rejection, with or without clinical repercussion, was present in 44.4% of the patients. Conclusion: Pediatric heart transplantation produces acceptable and feasible outcomes as definitive therapy for children with end-stage heart failure.

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.