Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Context: The GH/IGF-I axis has important interactions with the alimentary system and the balance between estimated energy intake (EEI) and estimated energy requirement (EER). Reduced EEI has been described in adult onset acquired GH deficiency, associated to other pituitary deficits. Individuals with isolated growth hormone deficiency (IGHD) due to a homozygous mutation (c.57+1G→A) in the GHRH receptor gene, living in Itabaianinha County in Brazil Northeastern, have abdominal obesity, without insulin resistance. EEI and EER are unknown in this unique cohort. Objectives: To evaluate EEI and EER in this IGHD cohort. Methods: Cross-sectional study of 24 IGHD individuals and 23 adult controls from the same region, matched for age and gender. IEE was evaluated by three food 24-hour recalls and EER by the equation of the Dietary Reference Intakes. Fat mass was assessed by DXA. Results: Both EEI and EER in absolute values were lower in IGHD. However, when corrected by body weight, EEI was higher in IGHD (p=0.005). IGHD individuals consume in percentage more proteins (p<0.0001), less carbohydrates (p=0.013) and equal lipids in comparison to controls. Conclusions: The higher estimated energy intake per body weight indicates a possible increase of orexigenic mechanisms in IGHD individuals, ensuring greater caloric intake, which would have adaptive advantages for small sized individuals, in environment with limited access to food. IGHD individuals seem have a healthier dietary pattern than CO. / Introdução: O eixo do hormônio de crecimento (GH) / fator de crescimento semelhante a isulina tipo I (IGF-I) tem interações importantes no consumo alimentar e no equilíbrio entre a ingestão energértica estimada (IEE) e a necessidade energética estimada (NEE). A baixa IEE é comum na deficiência de GH de início na idade adulta, associada a outras deficiências adquiridas da pituitária. Indivíduos com deficiência isolada de GH (DIGH), devido à mutação homozigótica c.57 + 1G → A no gene do receptor do GHRH, residentes em Itabaianinha no Nordeste do Brasil, apresentam obesidade abdominal, sem resistência à insulina. Nesta coorte a IEE e NEE são desconhecidos. Objetivos: Avaliar IEE e NEE neste modelo de DIGH. Casuística e Métodos: Estudo transversal em 24 indivíduos com DIGH e 23 controles adultos normais da mesma região, pareados por idade, gênero e percentual de massa gorda. Foi avaliada IEE por três recordatórios alimentares de 24 horas e NEE pela equação das Dietary Reference Intakes. A massa gorda foi avaliada por absorciometria de raios X de dupla energia (DXA). Resultados: Em valores absolutos a IEE e NEE foram menores nos indivíduos com DIGH. No entanto, quando corrigido pelo peso corporal, IEE foi maior no grupo com DIGH (p = 0,005). Os Indívuos com DIGH consomem em valores percentuais mais proteínas (p<0,0001), menos carboidratos (p = 0,013) e mesma quantidade de lípideos em comparação aos controles. Conclusões: A maior ingestão calórica por peso corporal indica um possível aumento dos mecanismos orexígenos nos indivíduos com DIGH, garantindo uma maior ingestão calórica, o que propiciaria vantagem adaptativa para pessoas de tamanho reduzido em um ambiente com acesso limitado a alimentos. Indivíduos com DIGH parecem ter um hábito alimentar mais saudável que os controles.

O objeto da presente investigação consiste em apresentar um estudo sobre como o gasto público pode comprometer as metas de cumprimento da Lei de Responsabilidade Fiscal. O estudo abrange a análise dos aspectos e peculiaridades do federalismo fiscal brasileiro, em face das dificuldades decorrentes da chamada guerra fiscal, deflagrada em virtude da autonomia dos entes federados, bem como pela busca de recursos tributários imediatos, a qualquer custo. No contexto da estrutura federativa, serão examinados os sucessivos projetos de reforma tributária. Ao final, serão propostas as possíveis soluções para a questão do descontrole da dívida pública, sob a perspectiva da Lei de Responsabilidade Fiscal. O tema é pertinente, notadamente em face dos clamores da sociedade para um refreamento no aumento da carga tributária, que atingiu índices sem precedentes históricos, e da crescente pressão por aumento dos gastos públicos, principalmente os relacionados com a seguridade social, ensino, segurança e saúde pública. / The object of this research is to present a study on how public expenditure could undermine the goals of compliance with the Fiscal Responsibility Law. The study covers the analysis of the features and peculiarities of the Brazilian fiscal federalism, in the face of difficulties arising from the so-called fiscal war breaks out because of the autonomy of federated entities, as well as the pursuit of immediate tax resources at any cost. In the context of federal structure, shall be reviewed successive drafts of the tax reform. In the end, it will be proposed the possible solutions to the issue of uncontrolled public debt, from the perspective of the Fiscal Responsibility Law. The theme is relevant, especially in the face of claims of society for a slowing in the increase of tax burden, which reached historically unprecedented rates, and increased pressure for higher government expenditure, especially those related to social security, education, public safety and health.

O texto discute o conceito e o regime jurídico dos incentivos e das renúncias fiscais no ordenamento jurídico brasileiro. Essas medidas jurídicas resultam do exercício da mesma competência legislativa que fundamenta a cobrança de tributos, mas os problemas jurídicos que suscitam não são exatamente os mesmos que se apresentam ordinariamente no debate tributário. Mais do que simplesmente normas tributárias, as leis que instituem incentivos fiscais configuram instrumentos para intervir na realidade social e modificá-la e precisam ser assim examinadas. Já não se trata apenas de resguardar o interesse privado do contribuinte contra a tributação indevida, excessiva ou intempestiva. O conflito entre fisco e contribuinte dá lugar à cooperação, e a norma tributária converte-se em ferramenta jurídica de indução de comportamentos e transformação da sociedade. Por isso, no estudo do tema, destaca-se não apenas a maneira como a regra de incentivo opera em relação ao dever fiscal, para eliminá-lo ou reduzi-lo, mas especialmente o modo como ela afeta a arrecadação fiscal e a conduta dos destinatários legais. Para tanto, propõe-se modelo de análise atento a três elementos: finalidade, regra e efeito externo. É fundamental considerar os propósitos que orientam a formulação da regra de incentivo, assim como os resultados concretos que produz. Essa forma de enxergar o fenômeno da exoneração fiscal favorece o controle de resultados e permite dar conta dos incentivos e renúncias fiscais como dois aspectos do mesmo fenômeno jurídico. / The text discusses the concept and legal regime of tax expenditure and tax incentives in the Brazilian Legal Framework. These measures derive from exercise of same legislative competency which establishes tax exaction, but the legal problems that derive from it are not exactly the same as those that included in revenue issue. More than simple fiscal rules, laws that constitute tax incentives are instruments of intervention and transformation of social reality, and need to be examined in this manner. It is no longer a question of safeguarding the taxpayers private interest against undue, excessive or hastily taxation. The conflict between the Public Treasury and taxpayers is replaced by cooperation, and the tax rule is converted into a legal instrument used to induce behaviors and to transform society. Hence, while studying the topic, not only how incentives rules relate to fiscal duty in order to eliminate or reduce it matter, but especially how they affect tax exaction and the conduct of its legal receiver. Therefore, an analytical model composed of the following three elements is proposed: purpose, rule and external effect, It is also fundamental to consider the intentions that guide formulation of incentives rule and its actual results. The way of foreseeing the fulfillment a tax duty enhances control over its results and allows rendering tax waivers incentives as two aspects of the same legal phenomenon.

O total de gasto social do governo somou cerca de R$800 bilhões em 2009, quase 25% do PIB brasileiro. Dado este volume crescente e expressivo, esta dissertação apresenta uma análise do efeito do gasto social sobre a pobreza no Brasil das três instâncias de governo: federal, estadual e municipal. Para tanto, foram estimados três modelos com dados em painel de 20 anos (1987 a 2009) analisando os gastos estaduais e federais. Adicionalmente, estimou-se o efeito da despesa municipal utilizando dados de 1991, 2000 e 2010 para 5.058 municípios. Procurou-se tratar o viés de simultaneidade entre o gasto do governo e a pobreza aplicando-se o modelo de mínimos quadrados em dois estágios, utilizando variáveis de ideologia política como instrumento. Os resultados mostraram que o gasto das três instâncias de governo tem efeito sobre a queda da pobreza no Brasil. Particularmente, as funções orçamentárias de gasto que apresentaram maior efetividade sobre a queda da pobreza foram: gasto federal e municipal com saúde e saneamento e gastos agregados estaduais e municipais. Analisou-se também o efeito da interação do gasto estadual com dados das condições iniciais de cada estado em 1980 - renda familiar per capita, desigualdade, proporção de pobres, grau de educação e mortalidade infantil. Concluiu-se que tanto as condições iniciais de cada estado como suas características específicas influenciam o grau em que o seu gasto afeta a pobreza. / The total public social spending in Brazil reached about R$800 billion in 2009, almost 25% of Brazilian GDP. Giving this increasing and expressive volume, this dissertation analyzes the effect of the three levels of government social spending on poverty in Brazil - federal, state and municipal. Three models were estimated with a 20 year\'s state panel data (1987 to 2009) analyzing the federal and state spending effect. We also estimated the municipal expenditure effect on poverty using data from 1991, 2000 and 2010 in 5.058 municipalities. The simultaneity bias between government spending and poverty was treated by applying the two stages least squares method, using the political ideology as instrumental variables. The results showed that the spending of the three levels of government reduce poverty in Brazil. Particularly, the spending budget functions with higher effectiveness on reduce poverty are: federal and municipal spending on health and sanitation, state and local aggregated spending. In addition, we also analyzed the effect of the state spending data interacting with its initial conditions in 1980 - per capita income, inequality, poverty, level of education and infant mortality. We concluded that the states initial conditions as well as its specific characteristics influence the extent to which their spending affects poverty.

This paper aims to measure the relationship between systemic vulnerability and government development investments. Systemic vulnerability is a concept introduced by Doner et al. (2005), which suggests that broad coalitions, severe external threats and scarce resources will lead to developmental states. Developmental states have several definitions that can generally be divided into structural and ideological features. Structural features include aspects related to state capacity and bureaucratic robustness, while ideological features refer to a stated goal of development. However, the term “developmental state” is also used as a political buzzword, which has diluted the academic concept. Education investments are used as a proxy for development investments because of the long-term societal and economic benefits that education has in a society. The study combines theories of political behavior, state-building and rentier states for the argument that systemic vulnerability should be positively correlated with education investments. Analysis is based on data from 73 countries and it shows that only some components of systemic vulnerability are correlated with education investments. The weak relationship between scarce resources and education investment follows the expected trend, while the relationship between external threat and education investment is unexpectedly negative. The broad coalitions show no statistically significant correlation between coalition size and education investment. These findings make a contribution to the field of development studies by expanding the understanding of the impact that systemic vulnerability has on development, since there has not been a large-n test of the concept on development investments before.

This paper provides a non-technical overview of NEG models dealing with policy issues. Considered policy measures include alternative categories of public expenditure, international tax competition, unilateral actions of protection/liberalisation, and trade agreements. The implications of public intervention in two-region NEG models are discussed by unfolding the impact of policy measures on agglomeration/dispersion forces. Results are described in contrast with those obtained in standard non-NEG theoretical models. The high degree of abstraction limits the applicability of NEG models to real world policy issues. We discuss in some detail two extensions of NEG models to reduce this applicability gap: the cases of multi-regional frameworks and firm heterogeneity.

The focus of this dissertation is local government expenditure, where growth, quality, and equality is in the center of attention Essay 1: Sports and Local Growth in Sweden: Is a Sports Team Good for Local Economic Growth? The purpose of Essay 1 is to analyzethe effect of professional sports on the municipality’s tax base. I find no indications of a positive effect on the growth rate of per capita income from having a team in the top series. Essay 2: Equality of Quality of Day Activity Service Programs in Sweden. In this Essay we investigates the equality of the day activity service programs for people with intellectual disabilities provided by local governments in Sweden. The findings are that despite the Act concerning Support and Service for Persons with Certain Functional Impairments intended to secure equality in living conditions, the quality of day activity service programs seems to be dependent on the local government’s tax base as well as the political preferences. In Essay 3: Analysis of Cost and Quality Indicators of Day Activity Service Programs in Sweden, we analyze the distribution of observable quality indicators for daily activity service programs. We find that municipalities that conduct regular user surveys find reasons to spend more per user on average. Additionally, the probability for transitions to employment at a regular workplace is higher in municipalities where as a routine a review is made of whether each participant can be offered an internship or work. The objective of Essay 4: The Composition of Local Government Expenditure and Growth: Empirical Evidence from Sweden, is to analyze whether there is a possibility of enhancing the average income growth rate at the local level by redistributing expenditure between main functional areas of local governments, while keeping the budget restriction fixed. We find that devoting large shares of expenditure on areas that increase labor supply, such as child care are positively related to growth in income. Additionally we find that spending areas previously categorized as productive can have a non-linier relationship with growth.

The rupture of an aneurysm in subarachnoid hemorrhage (SAH) is a dramatic event causing a severe impact on the brain and a transient or permanent ischemic condition. Several types of responses to meet the challenges of SAH have been found in the acute phase, including activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, elevated levels of brain natriuretic peptide (BNP), and disturbances in cerebral and systemic metabolism. Cerebral metabolism and the endocrine stress response in the ultra-early phase was investigated in a novel porcine model of SAH in which autologous blood was injected to the anterior skull base. Early activation of the HPA axis was found with rapid elevation of adrenocorticotrophic hormone, cortisol and aldosterone. The peak values of these hormones were early and may be impossible to catch in patients. There were indications of a sympathetic nervous response with excretion of catecholamines in urine as well as plasma chromogranin-A elevation. Cerebral microdialysis suggested immediate substrate failure followed by hypermetabolism of glucose. The animal model seems suited for further studies of aneurysmal SAH. NT-proBNP was investigated in 156 patients with SAH, there was a dynamic course with increasing levels during the first 4 days of the disease. Factors predicting high NT-proBNP load included female sex, high age, high Troponin-I at admission, angiographic finding of an aneurysm and worse clinical condition at admission. High levels of NT-proBNP were correlated to factors indicating a more severe disease, suggesting the initial injury in aneurysmal SAH is an important factor in predicting high NT-proBNP during the acute stage of the disease. Measurements with indirect calorimetry were performed daily during the first week after SAH on 32 patients with SAH. There was a dynamic course with increasing energy expenditure (EE) the first week after SAH. Comparisons with three predictive equations indicated that measured EE generally is higher than predicted, but considerable variation exists within and between patients, indicating that prediction of EE in SAH is difficult. Altogether, the studies demonstrate a complicated response in acute SAH that needs to be further studied to increase possibility of good outcome in SAH patients.

This paper provides a non-technical overview of NEG models dealing with policy issues. Considered policy measures include alternative categories of public expenditure, international tax competition, unilateral actions of protection/liberalisation, and trade agreements. The implications of public intervention in two-region NEG models are discussed by unfolding the impact of policy measures on agglomeration/dispersion forces. Results are described in contrast with those obtained in standard non-NEG theoretical models. The high degree of abstraction limits the applicability of NEG models to real world policy issues. We discuss in some detail two extensions of NEG models to reduce this applicability gap: the cases of multi-regional frameworks and firm heterogeneity.

There is a high prevalence in malnutrition among traumatic brain injury (TBI) due to the hypermetabolism and hypercatabolism which develop post injury. Traumatic brain injury patients are different, even among themselves, in their energy requirements and response to nutritional therapy. This implies that there are other factors that affect the energy intake of these patients and enhance the incidence of malnutrition. This dissertation study examines the nutritional status of TBI patients upon admission to the intensive care unit (ICU) and during their hospital stay to describe baseline status, detect changes in nutritional status over 7 days, and identify the factors affecting the adequacy of energy intake and the change in nutritional status as a consequence. Anthropometric measurements, biomedical measurements, measures of severity of illness, daily health status, level of brain injury severity, and other data were collected from the medical records of 50 patients, who were ≥ 18 years old, mechanically ventilated in the first 24 hours of ICU admission, and had a Glasgow Coma Scale score between 3-12. These data were used to examine the previous relationships. Although there was no statistically significant change found in body mass index and weight, there was a significant change detected in other nutritional markers, including hemoglobin, albumin, and total lymphocyte levels over the 7 days of ICU and hospital stay. No significant relationship was found between the adequacy of energy intake and total prescribed energy, severity of illness, level of brain injury severity, daily health status, patient age, intracranial pressure, or time of feeding initiation. Findings may be used to develop and test interventions to improve nutritional status during the acute phase of TBI. This will lay a foundation for health care providers, including nurses, to establish standards for practice and nutrition protocols to assure optimal nutrition assessment and intervention in a timely manner.