A Luenberger index for the Greek life insurance industry

This paper uses the Luenberger productivity index to evaluate the productivity changes of Greek Life insurance companies between 1994 and 2003, combining operational and financial variables. It is found that the average annual productivity change was about 19% and was due to technological progress, whereas the impact of efficiency was minimal. It seems that deregulation, established by the Third Insurance Directive in 1994, provoked investments in new technologies which were not matched by superior managerial practices. For comparative purposes, a Malmquist productivity index is estimated.peer-reviewe

Socioeconomic position early in adolescence and mode of delivery later in life: findings from a portuguese birth cohort

Objective: This study assessed the influence of socioeconomic position at 12 years of age (SEP-12) on the variability in cesarean rates later in life. Methods: As part of the Portuguese Generation XXI birth cohort we evaluated 7358 women with a singleton pregnancy who delivered at five Portuguese public hospitals serving the region of Porto (April/2005–September/2006). Based on the twelve items that described socioeconomic circumstances at age 12, a latent class analysis was used to classify women’s SEP-12 as high, intermediate and low. Multiple Poisson regression was used to estimate adjusted risk ratio (RR) and respective 95% confidence interval (95% CI). Results: The cesarean rates in high, intermediate and low SEP-12 were, respectively, 40.9%, 37.5% and 40.5% (p=0.100) among primiparous women; 14.2%, 11.6% and 15.5% (p=0.04) among multiparous women with no previous cesarean and 78.6%, 72.2% and 70.0% (p=0.08) among women with a previous cesarean. A low to moderate association between SEP-12 and cesarean rates was observed among multiparous women with a previous cesarean, illustrating that women from higher SEP-12 were more likely to have a surgical delivery (RR=1.12;95%CI:1.01-1.24 comparing high with low SEP-12 and RR=1.03:95%CI:0.94-1.14 comparing intermediate with low SEP-12) not explained by potential mediating factors. No such association was found either in primiparous or in multiparous women without a previous cesarean. Conclusions: The association between SEP-12 and cesarean rates suggests the effect of past socioeconomic context on the decision concerning the mode of delivery, but only among women who experienced a previous cesarean. Accordingly, it appears that early-life socioeconomic circumstances drive cesarean rates but the effect can be modified by lived experiences concerning childbirth

Analysing the efficiency of the Greek life insurance industry

This paper uses the DEA-CCR and the DEA-BCC models to evaluate the performance of Greek life insurance companies in the period 1994 to 2003, combining operational and financial variables. These models identify adequately the inefficient companies, but are weak in discriminating among those found to be efficient. To improve the results, we employ the Cross-Efficiency and the Super- Efficiency models. We estimate an inefficiency gap of about 27%. Furthermore, by using the Mann-Whitney Z-Test, we find that large and quoted life insurance companies, as well as those involved in mergers and acquisitions, exhibit higher efficiency. A major finding is that the local market is in great need of further consolidation.peer-reviewe

Analysing the efficiency of the Greek life insurance industry

This paper uses the DEA-CCR and the DEA-BCC models to evaluate the performance of Greek life insurance companies in the period 1994 to 2003, combining operational and financial variables. These models identify adequately the inefficient companies, but are weak in discriminating among those found to be efficient. To improve the results, we employ the Cross-Efficiency and the Super Efficiency models. We estimate an inefficiency gap of about 27%. Furthermore, by using the Mann-Whitney Z-Test, we find that large and quoted life insurance companies, as well as those involved in mergers and acquisitions, exhibit higher efficiency. A major finding is that the local market is in great need of further consolidation.info:eu-repo/semantics/publishedVersio

Testing an adaptation of the EPIC physical activity questionnaire in Portuguese adults: a validation study that assesses the seasonal bias of self-report

Background: No self-report method to measure different types and intensities of physical activity (PA) in adults has been tested in the Portuguese population. We assessed the validity, reproducibility and seasonal bias on past-year PA reporting. Subjects and methods: A sample of 953 Portuguese adults was evaluated between 2001 and 2003. A 4x7-day PA diary was used as a reference method to evaluate the validity of the EPIC questionnaire adapted for the Portuguese population (n = 114). Spearman’s correlation coefficients were calculated and agreement was tested using Bland–Altman plots. Trigonometric linear models were used to assess the seasonal variation. Results: Correlations between the questionnaire and the diaries were 0.56, 0.50, 0.88 and 0.78 for total, rest, occupational and leisure-time PA, respectively. The coefficients for reproducibility (2–3 months interval) ranged between 0.80 for leisure and 0.91 for occupational. Visualizing Bland–Altman plots, only rest PA revealed a tendency towards an increase in differences with increasing rest reported. Males interviewed in April and August reported the highest and lowest mean of leisure-time PA, respectively. For professional activities, the probability of amplitude being over one-half standard deviation was 33%. Conclusions: The questionnaire is a valid and reproducible instrument for the brief assessment of usual energy expenditure in adults, detailing different types of PA. In males, seasonal bias on reporting leisure-time and professional PA was found

Propriedades psicométricas do Eating Disorders Inventory em adolescentes portugueses

Introdução: Vários estudos sobre as perturbações do comportamento alimentar em adolescentes utilizam o Eating Disorders Inventory (EDI) apesar de este instrumento ter sido desenvolvido em adultos. No sentido de aumentar a sua utilidade clínica e em investigação, é importante analisar as qualidades psicométricas do EDI quando usado em indivíduos mais jovens do que aqueles em que foi desenvolvido. Neste estudo examinam-se as características psicométricas do EDI em adolescentes portugueses de 13 anos. Métodos: A amostra inclui 1184 adolescentes (641 raparigas e 543 rapazes), nascidos em 1990 e inscritos nas escolas públicas e privadas da cidade do Porto, que integram a coorte EPITeen. A auto-aplicação das escalas (EDI e Escala de Silhuetas de Stunkard) e as avaliações antropométricas foram realizadas nas escolas. Para análise das características psicométricas, foi avaliada a consistência interna e utilizada a análise de componentes principais seguida de rotação varimax. Na análise da validade de construto, as variáveis quantitativas foram comparadas com recurso aos testes de Mann-Whitney e Kruskal-Wallis. Resultados: Dos 64 itens que compõem o EDI, 17 mostraram-se inconsistentes. Após a sua exclusão, foi extraída uma solução com sete componentes principais, que explicaram 49,8% da variância total. Nesta solução foram definidas oito subescalas que apresentaram valores de alfa de Cronbach a variar de 0,53 a 0,87. As três subescalas que avaliam aspectos centrais nas perturbações do comportamento alimentar (Impulso para Emagrecer, Bulimia e Insatisfação Corporal) apresentaram boas características psicométricas e à excepção do item 1 (correlação item-total= 0,00), os itens mostraramse consistentes (correlação item-total a variar de 0,41 a 0,73; alfa de Cronbach a variar entre 0,77 a 0,87). Em consonância com os pressupostos teóricos previamente definidos, as raparigas em comparação com os rapazes (4,0 vs 1,7; p <0,001) e os adolescentes em risco de excesso de peso ou com excesso de peso em comparação com os normoponderais, apresentaram valores médios significativamente superiores na subescala Impulso para Emagrecer. Os adolescentes classificados como insatisfeitos ou muito insatisfeitos na escala de silhuetas apresentaram valores médios significativamente superiores na subescala Insatisfação Corporal. Conclusão: A versão portuguesa do EDI apresentou boas características psicométricas na avaliação de sintomatologia associada a perturbações do comportamento alimentar em adolescentes, em particular através das subescalas Impulso para Emagrecer, Bulimia, e Insatisfação Corporal, que se mantiveram consistentes com as subescalas originais. O instrumento é capaz de distinguir grupos de acordo com os construtos teóricos.Introduction: Although Eating Disorders Inventory (EDI) was developed with adults, a large amount of research about eating disorders in adolescents is usually conducted with EDI. The clinical and research utility of this instrument would be improved by analysing its psychometric properties when used with younger people than those in the original standardization samples. The main objective of our study is to analyse the psychometric properties of the Eating Disorders Inventory (EDI) among 13 year old Portuguese adolescents. Methods: A sample of 1184 adolescents (641 girls and 543 boys) born in 1990 and attending public and private schools in Porto completed EDI and was evaluated with Stunkard Figure Scale at school. Anthropometric measurements were also performed. Internal consistency was analysed trough item-total correlations and Cronbach's alpha coefficients. Mann-Whitney and Kruskal-Wallis tests were used to evaluate construct validity. Results: After the exclusion of 17 of the 64 items that showed low consistency, a correlation matrix of seven principal components, that explained 49.8% of the total variance, was obtained. In this matrix, 8 subscales with alpha ranging from 0.53 to 0.87 were defined. The three core EDI subscales (Drive for Thinness, Bulimia and Body Dissatisfaction) presented good psychometric properties and, except item 1 (itemtotal correlation= 0.00), items showed good internal consistency (item-total correlations ranging from 0.41 and 0.73, Cronbach's alpha ranging from 0.77 and 0.87). In accordance with theoretical constructs previously defined, girls presented higher mean scores than boys on Drive for Thinness subscale (4.0 vs. 1.7, p < 0.001). Also, adolescents with a healthy weight presented significantly lower scores than overweight adolescents in the same subscale. Boys and girls classified as dissatisfied or very dissatisfied with body image according to Stunkard Figure Rating Scale presented significantly higher scores on Body Dissatisfaction EDI subscale. Conclusion: The Portuguese version of EDI, with the proposed changes, showed good psychometric characteristics to evaluate symptoms associated with eating disorders among 13 year old adolescents. The subscales Drive for Thinness, Bulimia and Body Dissatisfaction, besides presenting good psychometric properties, remained similar to the same subscales in the original EDI. The instrument is able to distinguish groups according to theoretical constructs

Latent models in the development and improvement of tools for health outcomes measurement

Saúde PúblicaDoctoral Programme in Public Healt

Hematopoietic stem cell transplantation in chronic lymphoid leukemia: a proposal by the Brazilian Consensus on Bone Marrow Transplantation of the Brazilian Society of Bone Marrow Transplantation, Rio de Janeiro 2009

Portadores de leucemia linfoide crônica (LLC) apresentam curso clínico indolente e prolongado que devem ser diferenciados daqueles que têm doença de evolução agressiva e fatal. Pacientes mais jovens e com critérios de alto risco podem se beneficiar com tratamento mais agressivo como o transplante de células-tronco hemopoéticas (TCTH). O transplante autólogo apresenta casos com remissão citogenética e molecular, baixa taxa de mortalidade, mas não demonstram platô nas curvas de sobrevivência e alta taxa de recaídas. Os transplantes alogênicos com regime mieloablativos têm altos índices de toxicidade e mortalidade, mas evidenciam o efeito enxerto versus leucemia, que aumenta a possibilidade de cura destes indivíduos. Assim, a opção dos transplantes alogênicos está dirigida para os transplantes com regime de condicionamento não mieloablativo, que pode ser aplicado inclusive a pacientes mais idosos ou portadores de comorbidades, e manter o potencial efeito GVL. A identificação dos pacientes que podem ser beneficiados por esses procedimentos, caracterizar e apontar os novos marcadores prognósticos permanece objeto de muitos estudos clínicos e foi o objetivo do grupo responsável em discutir as diretrizes do TCTH no consenso da Sociedade Brasileira de Transplante de Medula Óssea - SBTMO. Assim, consideramos que o TCTH para a leucemia linfoide crônica (LLC) deve seguir, para sua indicação, os critérios do European Group for Blood and Marrow Transplantation (EBMT) e, quando houver disponibilidade de um doador aparentado, a opção deve ser do TCTH alogênico com regime não mieloablativo. O TCTH alogênico não aparentado e o autólogo devem ser considerados como opção secundária de indisponibilidade de doador, situações especiais e ensaios clínicos.Patients with chronic lymphocytic leukemia usually have an indolent and prolonged clinical course and need to be differentiated from those who have an aggressive and fatal disease. Younger patients with high-risk criteria may benefit with a more aggressive treatment that includes hematopoietic stem cell transplantation (HSCT). Autologous transplantation, despite of the encouraging results with cases of molecular and/or cytogenetic remission and low mortality rates, does not present a plateau in survival curves and has a high relapse rate. Allogeneic transplantations using myeloablative regimens, have high toxicity and mortality rates, but also demonstrate the graft-versus-leukemia effect that increases the possibility of cure of these individuals. So the option of allogeneic transplants for patients with CLL is directed to conditioning using non-myeloablative regimens, which can also be applied to older patients or those with comorbidities, and maintain a potential graft-versus-leukemia effect. The identification of patients who may benefit from these procedures and the characterization of new prognostic markers remain the subjects of many clinical studies and were the objective of the group responsible for discussing guidelines for CLL of the consensus on HSCT SBTMO. Thus we believe that HSCT for CLL should follow the criteria of the EBMT. When a sibling donor is available the best option is allogeneic HSCT with a myeloablative regimen. The strategy of unrelated allogeneic or autologous HSCT must be considered as a second option when no donor is available, for special situations and clinical trials