Reforming the Pay-As-You-Go Pension System: Who Votes for it ? When?

We assess the political support for parametric reforms of the Pay-As-You-Go pension system following a downward fertility shock. Using a continuous time overlapping generations model, we argue that reforms that consist in cutting pension benefits or increasing the retirement age are likely to receive a strong political support. An increase in the contribution rate has, on the contrary, fewer chances to be approved by the majority of the voters. This framework also allows to identify the costs and benefits of postponing each type of reform and to determine how the timing of the different reforms affects their political support

Reforming the Pay-As-You-Go Pension System: Who Votes for it ? When?

We assess the political support for parametric reforms of the Pay-As-You-Go pension system following a downward fertility shock. Using a continuous time overlapping generations model, we argue that reforms that consist in cutting pension benefits or increasing the retirement age are likely to receive a strong political support. An increase in the contribution rate has, on the contrary, fewer chances to be approved by the majority of the voters. This framework also allows to identify the costs and benefits of postponing each type of reform and to determine how the timing of the different reforms affects their political support

Nurturing care indicators for the Brazilian Early Childhood Friendly Municipal Index (IMAPI)

The Nurturing Care Framework (NCF) calls for establishing a global monitoring and accountability systems for early childhood development (ECD). Major gaps to build low-cost and large-scale ECD monitoring systems at the local level remain. In this manuscript, we describe the process of selecting nurturing care indicators at the municipal level from existing routine information systems to develop the Brazilian Early Childhood Friendly Index (IMAPI). Three methodological steps developed through a participatory decision-making process were followed. First, a literature review identified potential indicators to translate the NCF domains. Four technical panels composed of stakeholders from federal, state and municipal levels were consulted to identify data sources, their availability at the municipal level and the strengths and weakness of each potential indicator. Second, national and international ECD experts participated in two surveys to score, following a SMART approach, the expected performance of each nurturing care indicator. This information was used to develop analytical weights for each indicator. Third, informed by strengths and weaknesses pointed out in the previous steps, the IMAPI team reached consensus on 31 nurturing care indicators across the five NCF domains (Good health [n = 14], Adequate nutrition [4], Responsive caregiving [1], Opportunities for early learning [7] and Security and safety [4]). IMAPI represents the first attempt to select nurturing care indicators at the municipal level using data from existing routine information systems

Efeitos e aplicabilidade da terapia espelho na neurorreabilitação - revisão de literatura / Effects and applicability of mirror therapy in neurorehabilitation - literature review

Introdução: A Terapia Espelho (TE) foi originalmente desenvolvida na década de 90, pelo neurocientista indiano Ramachandran. A técnica utiliza um espelho posicionado no plano médio sagital, entre o membro afetado e o membro saudável, fornecendo feedback visual do membro saudável e gerando a sensação de dois membros móveis, como se o membro afetado estivesse realizando movimentos saudáveis no hemicampo negligenciado. Isso resulta na excitabilidade corticoespinhal e das áreas somatossensoriais, contribuindo para a recuperação motora. Objetivo: Identificar a aplicabilidade e os efeitos da Terapia Espelho como recurso da reabilitação neurológica.   Materiais e métodos: Trata-se de uma revisão de literatura, onde as bases de dados utilizadas foram Pedro, SciELO, PubMed e Lilacs, no período de Setembro de 2017 a Outubro de 2018. Utilizou-se como estratégia de pesquisa, nas bases de dados, a combinação dos descritores de acordo com o idioma. Além disso, foi realizada a busca manual na lista de referências dos artigos apresentados. Os estudos foram submetidos a uma avaliação da qualidade metodológica, utilizando-se a escala PeDro. Resultados: Foram encontrados 62 artigos, porém apenas 9 foram analisados. Eram compostos por amostras de indivíduos com diagnóstico de dor fantasma por amputação, Paralisia Cerebral (PC), lesão traumática cerebral ou Acidente Vascular Cerebral (AVC) em suas fases aguda, subaguda e crônica. Os instrumentos de avaliação variaram entre os estudos, assim como o modo de execução, a frequência e a duração do tratamento. Conclusão: A TE é benéfica para a recuperação motora de membros superiores e inferiores, função sensório-motora e para a diminuição da dor. Porém, a literatura voltada para o modo de execução da TE é muito escassa e existem muitas controvérsias em relação ao protocolo utilizado, tornando-se necessária a realização de novos estudos com maior número amostral, de modo que possam obter resultados mais significativos e amplos

Reforming the Pay-As-You-Go Pension System: Who Votes for it ? When?

We assess the political support for parametric reforms of the Pay-As-You-Go pension system following a downward fertility shock. Using a continuous time overlapping generations model, we argue that reforms that consist in cutting pension benefits or increasing the retirement age are likely to receive a strong political support. An increase in the contribution rate has, on the contrary, fewer chances to be approved by the majority of the voters. This framework also allows to identify the costs and benefits of postponing each type of reform and to determine how the timing of the different reforms affects their political support.Pay-As-You-Go, parametric reforms, fertility shock

Endoscopic skull base surgery: evaluation of current clinical outcomes

Endoscopic skull base surgery is one of the most recent fields of neurosurgery. Successive innovations were developed throughout history so that the current concepts that rule this surgical field could be reached. The current paper presents the evolution of endoscopic surgery and its current results on the treatment of skull base tumor, based on a review of meta-analysis and clinical series. A PubMed search for articles published between January 1990 and January 2014 about "endoscopic skull base surgery", "endoscopic transsphenoidal approach", "endoscopic treatment of parasellar tumors" and "suprasellar lesions" was performed. According to the current data, endoscopic surgery seems to be superior to open and transsphenoidal microscopic removal of giant pituitary adenomas. Endoscopy is at least as successful as transsphenoidal microsurgery for the removal of pituitary adenomas and craniopharyngiomas. Transcranial open approaches, in the context of anterior midline skull base meningiomas, present higher rates of gross total resection, fewer complications and better clinical results than endoscopy approaches. The rate of postoperative CSF leakage has been significantly reduced with the introduction of new techniques such as the Hadad-Bassagasteguy flap but still represent one of the most important complications of this technique. Currently, selected tumors located at the anterior, middle and posterior fossa can be adequately assessed using the endoscope with low rates of postoperative CSF leaks. Endoscopic surgery has substantially evolved in the last decades through the collaboration of different teams around the world. The endoscope is now an essential tool in the neurosurgery armamentarium with great potential for new applications in the nearby future.631889

Y-TZP surface behavior under two different milling systems and three different accelerated aging protocols

BACKGROUND: To evaluate the influence of aging and milling system on zirconia surface roughness (SR) and phase transformation. METHODS: Eighty crowns were divided in two groups according to yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramic milling system (CAD-Neodent or MAD-Zirkonzahn). The crowns were submitted to different aging protocols (N.=10): 1) no aging; 2) autoclaving; 3) pH cycling; or 4) thermocycling. Next, the samples were submitted to an optical profilometry analysis to determine differences in the S R (um). A n X-ray diffraction analysis (XRD) was performed to quantify the percentage of monoclinic phase transformation. SR data was analyzed by two-way A NOVA (a=0.5%). RESULTS: Aging protocol (P=0.42) and milling system (P=0.08) had no influence on the SR. However, the number of monoclinic phases was influenced by the autoclaving and pH cycling. CONCLUSIONS: The surface roughness of zirconia-based crowns was not influenced by low temperature degradation or milling system. Regarding the phase transformation, autoclaving and pH-cycling aging presented a monoclinic phase increase when compared to the control group and thermocycled groups

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments