Longevity risk: A methodology for assessing in a Solvency II perspective

This paper considers the assessment of longevity risk in the context of alongevity indexed life annuities. The framework is set up in a way that accommodatesa variety of regulatory regimes such as Solvency II as well aslocal actuarial practice, attempting to bridge the gap between academia andpractice. In the following the authors compare the results obtained in a SolvencyII perspective with those obtained with a partial internal model. Thepredictions contained in both models are compared with the real probabilitiesin order to evaluate the deviations due to life expectancy improvements

THE COVID-19 EFFECT ON SECURITY MORTGAGE VALUATION

The reverse mortgage market has been expanding rapidly in developed economies in recent years. Reverse mortgages provide an alternative source of funding for retirement income and health care costs. We often hear the phrase “house rich and cash poor” to refer the increasing number of elderly persons who hold a substantial proportion of their assets in home equity. Reverse mortgage contracts involve a range of risks from the insurer’s perspective. When the outstanding balance exceeds the housing value before the loan is settled, the insurer suffers an exposure to crossover risk induced by three risk factors: interest rates, house prices, and mortality rates. In this context, Covid-19 has occurred and the insurer is faced with this additional source of risk. We analyse the combined impact of these risks on the pricing and the risk profile of reverse mortgage loans. We consider a CIR process for the evolution of the interest rate, a Black & Scholes model for the dynamics of house prices and the Gompertz model for the trend in mortality Our results show that the decrease in the mortality curve due to Covid exposes the insurer to higher risks once the shock is reabsorbed. The risk is higher the higher the age of entry. Only a significant reduction of the shock adjustment coefficient will return the situation to normalit

The security mortgage valuation in a stochastic perspective

The reverse mortgage market has been expanding rapidly in developed economies in recent years. Reverse mortgages provide an alternative source of funding for retirement income and health care costs. Increase in life expectancies and decrease in the real income at retirement continue to worry the those who are retired or close to retirement. Therefore, financial products that help to alleviate the “risk of living longer” continue to be attractive among the retirees. Reverse mortgage contracts involve a range of risks from the insurer’s perspective. When the outstanding balance exceeds the housing value before the loan is settled, the insurer suffers an exposure to crossover risk induced by three risk factors: interest rates, house prices and mortality rates. We analyse the combined impact of these risks on the pricing and the risk profile of reverse mortgage loans in a stochastic interest-mortality-house pricing model. Our results show shows  that pricing of reverse mortgages loans does not accurately assess the risks underwritten by reverse mortgages lenders and that failing to take into account mortality improvements substantially underestimates the longevity risk involved in reverse mortgage loans

Prevalência da doença periodontal de uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar (USF) Espinho

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaA doença periodontal (DP), de acordo com a Academia Americana de Periodontia (AAP), é uma doença inflamatória crónica, que afeta os tecidos da gengiva e do osso encarregados de sustentar as peças dentárias; em meados do século XX, acreditava-se que todas as espécies de bactérias no biofilme bacteriano tinham igual capacidade de causar doença, mas a proporção de espécies de bactérias específicas responsáveis DP só foi estabelecida entre 1960 e 1970; segundo aos dados da Organização Mundial da Saúde (OMS), o 90% da população mundial sofre de esta doença; e a periodontite é o estágio mais avançado tendo muitos fatores que produzem a destruição progressiva do ligamento periodontal e o osso alveolar. Em Portugal, este problema assume particular gravidade dado que durante muitas décadas, a saúde oral não esteve acessível a toda a população, mas atualmente, é inquestionável a necessidade de programas nacionais que contemplem a promoção da Saúde Oral (SO), e a prevenção e tratamento das Doenças Orais (DO), que contribuam significativamente na melhora da Saúde Geral das populações. Estudos epidemiológicos utilizados na atualidade, encontram-se na procura de detectar placa, cálculo e hemorragia gengival, como indicadores da doença e, admite-se que os dois primeiros fatores são essenciais para promover a iniciação e a progressão da DP, com todas as tentativas para tomar referências e poder medir e repetir medições para avaliar a evolução da DP, criaram-se os índices periodontais para ter uma forma de detectar a prevalência da DP em populações. Em 1982 a OMS preconizou o CPITN (Communite Periodontal Index of Treatment Needs), o qual foi desenvolvido com propósito de ser o índice que avaliasse de forma rápida e simples a condição periodontal, mas tempo posteriormente para IPC (Índice Periodontal Comunitário); hoje amplamente aceite. Devido à necesidade da procura de novas medições com fim de observar os valores de incidência da DP em diferentes populações; o presente trabalho foi desenhado para determinar a “Prevalência da doença periodontal em uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar Espinho (USF) ”. Foi desenvolvido um estudo observacional, transversal e analítico no período entre Abril e Junho de 2014. A população foi constituída por 100 utentes inscritos na USF de Espinho, seleccionados aleatoriamente de entre os utentes que recorriam a consulta de Medicina Geral e Familiar. Objectivos Determinar a Prevalência da Doença Periodontal nos utentes vigiados na USF de Espinho. Determinar a associação entre a doença periodontal com outros factores individuais (sexo, higiene oral, hábitos tabágicos, utilização de prótese dentária). Resultados Observou-se que 80% da população possui doença periodontal, e em relação ao género, a doença encontra-se distribuida em 57% no género feminino, e 23% no género masculino. A profundidade à sondagem em 88% dos indivíduos examinados indicou que o 41% possui medidas de sondagem entre 4-5 mm, e 16% de ≥6 mm. Por outro lado, o 42% possuia uma perda de inserção a partir da junção esmalte-cimento entre 0-3mm, o 35% entre 4-5mm e por último o 23% apresentou uma perda de inserção entre 6-8 mm. O hábito de higiene oral foi representado com o 90% da população que realiza a higiene oral diária, e a distribuição observada do edentulismo, foi representada pelo 69% de indivíduos com edentulismo parcial, e o 12% com edentulismo total. Conclusão Apesar da alta prevalência de DP (80%) para este grupo de estudo, onde>50% da população possuem bolsas periodontais estabelecidas com perda de inserção de mais de 4 mm, um nível considerado da população realiza a higiene oral diária. Além disso, sendo a taixa de edentulismo parcial que lidera com o 69%, podemos concluir que com uma percentagem tão elevada de DP e classificando a maioria dos pacientes com algum tipo de edentulismo; para haver pouca quantidade de dentes examinados existe uma grande quantidade de dentes com DP. The periodontal disease (PD), with agreement with the American Academy of Periodontology, is a chronic inflammatory disease that affects the tissues of the gums and the bones in charge of sustaining dental parts; in the mid-twentieth century it was accepted that all the species of bacteria in dental plaque had the same capacity to cause disease; however, the proportion of bacterial species that was specifically responsible for PD was establish between 1960 and 1970. According to data from the World Health Organization (WHO), 90% percent of the world population suffers from this disease. The periodontitis is the most advanced stage, having many factors that produce progressive damage to periodontal ligaments and alveolar bones. In Portugal, this problem has reached a particular level of severity as the general population did not have accessibility to dental care for many decades. Although, recently there is no doubt that there have been national programs that promote oral health, as well as the prevention and the treatment of oral diseases (OD); these programs have contributed significantly to the improvement to the overall health of the population. Epidemiological studies currently used demand the detection of plaque, tartar, and hemorraging in the gums as indicators of disease and it is assumed that the first two factors are essential in the development and progress of a PD. With all the attempts to take references to be able to measure and evaluate the evolution of a PD, an index has been created to have a method to detect the prevalency of PD among the population. In 1982 the WHO recommended the CPITN (Community Peridontal Index of Treatment Needs), which was created with the purpose of being the index to rapidly evaluate the simple periodontal conditions. After time the organization would change into the now widely accepted ICP (Communal Periodontal Index). Due to the new medical necessities to provide observation of the impact levels of PDs in different populations; the current work is designed to determine the “Prevalence of periodontal disease among the population of health care clients subscribed to USF de Espinho. Materials and Methods An observational study was held transversely and analytically in USF Espinho between April and June of 2014. The population was made up of 100 clients subscribed to USF Espinho, and were randomly selected. Objectives Determine the prevalence of periodontal disease among the observed population in USF Espinho Determine the association of periodontal disease and other individual factors (gender, oral hygiene, smoking habits, etc.) Results It was observed that 80% of the population has periodontal disease, and in relation to gender, the disease is found distributed in 57% in females and 23% in males. The probing depth in 88% of pacients surveyed indicated that 41% of survey measures has between 4-5 mm, and 16% for ≥ 6 mm. On the other hand, 42% possessed an insertion loss from the cement-enamel junction between 0-3mm, 35% between 4-5mm and finally 23% exhibited an insertion loss between 6-8 mm. The habit of oral hygiene was represented with 90% of the population that performs daily oral hygiene, and the observed distribution of edentulism was represented by 69% of individuals with partial edentulism, and 12% with complete edentulism. Conclusion Despite the high prevalence of PD (80%) for this study group, where >50% of the population have established periodontal pockets with insertion loss of more than 4 mm, a level considered of the population performs daily oral hygiene. Furthermore, with a percentage of partial edentulous leading with 69%, we can conclude that with such a high percentage of DP and classifying the majority of patients with any type of tooth loss; to be little amount of teeth examined, there is a lot of teeth with PD

Prevalência da doença periodontal de uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar (USF) Espinho

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina DentáriaA doença periodontal (DP), de acordo com a Academia Americana de Periodontia (AAP), é uma doença inflamatória crónica, que afeta os tecidos da gengiva e do osso encarregados de sustentar as peças dentárias; em meados do século XX, acreditava-se que todas as espécies de bactérias no biofilme bacteriano tinham igual capacidade de causar doença, mas a proporção de espécies de bactérias específicas responsáveis DP só foi estabelecida entre 1960 e 1970; segundo aos dados da Organização Mundial da Saúde (OMS), o 90% da população mundial sofre de esta doença; e a periodontite é o estágio mais avançado tendo muitos fatores que produzem a destruição progressiva do ligamento periodontal e o osso alveolar. Em Portugal, este problema assume particular gravidade dado que durante muitas décadas, a saúde oral não esteve acessível a toda a população, mas atualmente, é inquestionável a necessidade de programas nacionais que contemplem a promoção da Saúde Oral (SO), e a prevenção e tratamento das Doenças Orais (DO), que contribuam significativamente na melhora da Saúde Geral das populações. Estudos epidemiológicos utilizados na atualidade, encontram-se na procura de detectar placa, cálculo e hemorragia gengival, como indicadores da doença e, admite-se que os dois primeiros fatores são essenciais para promover a iniciação e a progressão da DP, com todas as tentativas para tomar referências e poder medir e repetir medições para avaliar a evolução da DP, criaram-se os índices periodontais para ter uma forma de detectar a prevalência da DP em populações. Em 1982 a OMS preconizou o CPITN (Communite Periodontal Index of Treatment Needs), o qual foi desenvolvido com propósito de ser o índice que avaliasse de forma rápida e simples a condição periodontal, mas tempo posteriormente para IPC (Índice Periodontal Comunitário); hoje amplamente aceite. Devido à necesidade da procura de novas medições com fim de observar os valores de incidência da DP em diferentes populações; o presente trabalho foi desenhado para determinar a “Prevalência da doença periodontal em uma população de utentes em cuidados de saúde primários inscritos na Unidade Saúde Familiar Espinho (USF) ”. Foi desenvolvido um estudo observacional, transversal e analítico no período entre Abril e Junho de 2014. A população foi constituída por 100 utentes inscritos na USF de Espinho, seleccionados aleatoriamente de entre os utentes que recorriam a consulta de Medicina Geral e Familiar. Objectivos Determinar a Prevalência da Doença Periodontal nos utentes vigiados na USF de Espinho. Determinar a associação entre a doença periodontal com outros factores individuais (sexo, higiene oral, hábitos tabágicos, utilização de prótese dentária). Resultados Observou-se que 80% da população possui doença periodontal, e em relação ao género, a doença encontra-se distribuida em 57% no género feminino, e 23% no género masculino. A profundidade à sondagem em 88% dos indivíduos examinados indicou que o 41% possui medidas de sondagem entre 4-5 mm, e 16% de ≥6 mm. Por outro lado, o 42% possuia uma perda de inserção a partir da junção esmalte-cimento entre 0-3mm, o 35% entre 4-5mm e por último o 23% apresentou uma perda de inserção entre 6-8 mm. O hábito de higiene oral foi representado com o 90% da população que realiza a higiene oral diária, e a distribuição observada do edentulismo, foi representada pelo 69% de indivíduos com edentulismo parcial, e o 12% com edentulismo total. Conclusão Apesar da alta prevalência de DP (80%) para este grupo de estudo, onde>50% da população possuem bolsas periodontais estabelecidas com perda de inserção de mais de 4 mm, um nível considerado da população realiza a higiene oral diária. Além disso, sendo a taixa de edentulismo parcial que lidera com o 69%, podemos concluir que com uma percentagem tão elevada de DP e classificando a maioria dos pacientes com algum tipo de edentulismo; para haver pouca quantidade de dentes examinados existe uma grande quantidade de dentes com DP. The periodontal disease (PD), with agreement with the American Academy of Periodontology, is a chronic inflammatory disease that affects the tissues of the gums and the bones in charge of sustaining dental parts; in the mid-twentieth century it was accepted that all the species of bacteria in dental plaque had the same capacity to cause disease; however, the proportion of bacterial species that was specifically responsible for PD was establish between 1960 and 1970. According to data from the World Health Organization (WHO), 90% percent of the world population suffers from this disease. The periodontitis is the most advanced stage, having many factors that produce progressive damage to periodontal ligaments and alveolar bones. In Portugal, this problem has reached a particular level of severity as the general population did not have accessibility to dental care for many decades. Although, recently there is no doubt that there have been national programs that promote oral health, as well as the prevention and the treatment of oral diseases (OD); these programs have contributed significantly to the improvement to the overall health of the population. Epidemiological studies currently used demand the detection of plaque, tartar, and hemorraging in the gums as indicators of disease and it is assumed that the first two factors are essential in the development and progress of a PD. With all the attempts to take references to be able to measure and evaluate the evolution of a PD, an index has been created to have a method to detect the prevalency of PD among the population. In 1982 the WHO recommended the CPITN (Community Peridontal Index of Treatment Needs), which was created with the purpose of being the index to rapidly evaluate the simple periodontal conditions. After time the organization would change into the now widely accepted ICP (Communal Periodontal Index). Due to the new medical necessities to provide observation of the impact levels of PDs in different populations; the current work is designed to determine the “Prevalence of periodontal disease among the population of health care clients subscribed to USF de Espinho. Materials and Methods An observational study was held transversely and analytically in USF Espinho between April and June of 2014. The population was made up of 100 clients subscribed to USF Espinho, and were randomly selected. Objectives Determine the prevalence of periodontal disease among the observed population in USF Espinho Determine the association of periodontal disease and other individual factors (gender, oral hygiene, smoking habits, etc.) Results It was observed that 80% of the population has periodontal disease, and in relation to gender, the disease is found distributed in 57% in females and 23% in males. The probing depth in 88% of pacients surveyed indicated that 41% of survey measures has between 4-5 mm, and 16% for ≥ 6 mm. On the other hand, 42% possessed an insertion loss from the cement-enamel junction between 0-3mm, 35% between 4-5mm and finally 23% exhibited an insertion loss between 6-8 mm. The habit of oral hygiene was represented with 90% of the population that performs daily oral hygiene, and the observed distribution of edentulism was represented by 69% of individuals with partial edentulism, and 12% with complete edentulism. Conclusion Despite the high prevalence of PD (80%) for this study group, where >50% of the population have established periodontal pockets with insertion loss of more than 4 mm, a level considered of the population performs daily oral hygiene. Furthermore, with a percentage of partial edentulous leading with 69%, we can conclude that with such a high percentage of DP and classifying the majority of patients with any type of tooth loss; to be little amount of teeth examined, there is a lot of teeth with PD

Spesa pubblica, moltiplicatori fiscali e sostenibilità del debito pubblico

In questo lavoro si quantificano gli effetti della spesa pubblica e delle sue componenti, ossia i consumi e gli investimenti pubblici, sul livello del prodotto interno lordo e sul rapporto debito pubblico/PIL. Applicando un modello econometrico basato sul Local-Projection ad un panel di 14 Paesi OCSE, i risultati mostrano che i moltiplicatori della spesa pubblica totale sono positivi e intorno all’unità e i moltiplicatori degli investimenti pubblici sono più alti di quelli dei consumi. Quando si analizzano gli effetti delle politiche fiscali espansive sulla sostenibilità del debito pubblico, si osserva che tutti gli stimoli fiscali conducono ad una riduzione del rapporto debito/PIL, ma gli investimenti pubblici sono lo strumento più efficace per promuovere la sostenibilità del debito pubblic

The Atopy Index Inventory: A Brief and Simple Tool to Identify Atopic Patients

Introduction: Atopy and ear, nose and throat (ENT) diseases are frequently associated; however, no clinical tool has been proposed so far to discriminate which patients could be atopic and therefore deserving of a further immunoallergological evaluation. Objective: The aim of this study was to assess and validate a set of dichotomous responses suitable for predicting the presence of atopy in adult patients. Methods: An 11-item questionnaire, i.e., the Atopy Index Inventory (AII), comprised of 4 questions regarding the clinical history for allergic disease and 7 questions evaluating the presence of the most frequent clinical signs affecting allergic patients, was developed and administered to 226 adult subjects (124 atopic subjects and 102 healthy, not atopic subjects). The atopic condition was proven by an immunoallergological evaluation according to the diagnostic criteria of the EAACI guidelines. Internal consistency and clinical validity were tested. Results: In healthy subjects, the first 4 variables of the AII returned a 100% correct response (all answered \u201cno\u201d) and were defined as \u201cdecisive\u201d responses. In the logistic regression analysis, when decisive items were negative, the atopic condition was confirmed when answering \u201cyes\u201d to at least 3 \u201cprobability\u201d items (cutoff = 2.69). The difference in AII scores between allergic and healthy group was significant using the Mann-Whitney U test (p < 0.0001). The sensitivity and specificity of the AII were 0.97 and 0.91, respectively, with a true predictive value of 0.92 and a false predictive value of 0.97. The ROC curve showed an area of 0.94, with an OR of 0.88 (95% CI 0.87\u20130.97, p = 0.0001). The internal consistency as determined by the Cronbach \u3b1 coefficient was 0.88. Conclusion: The AII has been proven to be a brief, simple and sufficiently accurate tool for screening ENT patients in search of atopic individuals and to allow their clinical management

Malocclusion and rhinitis in children: an easy-going relationship or a yet to be resolved paradox? A systematic literature revision

Objective: The relation between nasal flow and malocclusion represents a practical concern to pediatricians, otorhinolaryngologists, orthodontists, allergists and speech therapists. If naso-respiratory function may influence craniofacial growth is still debated. Chronic mouth-breathing is reported to be associated also with a characteristic pattern of dental occlusion. On the other hand, also malocclusion may reduce nasal air flows promoting nasal obstruction. Hereby, the aim of this review was to describe the relationship between rhinitis and malocclusion in children. Methods: An electronic search was conducted using online database including Pubmed, Web of Science, Google Scholar and Embase. All studies published through to January 30, 2017 investigating the prevalence of malocclusion in children and adolescents (aged 0-20 years) affected by rhinitis and the prevalence of rhinitis in children with malocclusion were included. The protocol was registered at PROSPERO - International prospective register of systematic reviews under CRD42016053619. Results: Ten studies with 2733 patients were included in the analysis. The prevalence of malocclusion in children with rhinitis was specified in four of the studies ranging from as high as 78.2% to as low as 3%. Two out of the studies reported the prevalence of rhinitis in children with malocclusion with a rate ranging from 59.2 to 76.4%. Conclusion: The results of this review underline the importance of the diagnosis and treatment of the nasal obstruction at an early age to prevent an altered facial growth, but the data currently available on this topic do not allow to establish a possible causal relationship between rhinitis and malocclusion

Evaluation of fatigue in patients with pancreatic cancer receiving chemotherapy treatment: a cross-sectional observational study

Background and aim of the work: Cancer-related fatigue (CRF) is one of the most common symptoms experienced by cancer patients (CPs) and negatively affects quality of life. Although CRF is frequently experienced, it is often underreported, underdiagnosed and undertreated. The objectives of this study were to evaluate the level of fatigue in patients with pancreatic cancer undergoing chemotherapy and to analyse its correlation with patients\u2019 demographic and clinical variables. Methods: A cross-sectional observational study was implemented in the Oncology Day Hospital of a Northern Italian hospital. A sample of 48 patients receiving chemotherapy were evaluated through the Brief Fatigue Inventory Italian version (BFI-I) between 1 May and 12 October 2016. Data were statistically analysed. Results: Most of our patients (94%) experienced fatigue. Women as well as patients with an age 6565 years reported more fatigue. Anemia, pain and a weight loss of over 16 kg in the last 6 months were significantly related to the perception of fatigue. Regarding life habits, smoking was related to high global score of BFI-I. Conclusions: In accordance with literature, our study suggests that fatigue is a frequent symptom influenced by many constitutional, clinical and environmental factors. Our results highlight the need for an early and regular evaluation of fatigue among cancer patients, in order to implement all those pharmacological and non-pharmacological interventions with proven efficacy in attenuating this symptom