Introdução: As morbidades e mortalidade relacionadas ao uso de medicamentos (MRM) representam um desafio para a saúde pública e são consequências da utilização não efetiva e insegura dos medicamentos. Estudos internacionais mostram como as MRM afetam pacientes internados no hospital e como podem ser evitadas na maioria dos casos. Entretanto, pouco é conhecido sobre as MRM na prática ambulatorial. Estas pesquisas têm abordado as consequências clínicas negativas para os usuários de medicamentos e sugerem que vultosas somas de recursos financeiros são utilizadas para manejar e resolver estas morbidades ao redor do mundo. Já no Brasil, o conhecimento sobre as MRM é escasso em ambas perspectivas e o seu impacto econômico é desconhecido. Objetivo: O propósito desta Tese foi obter uma estimativa sobre os gastos com morbidade e mortalidade associadas ao uso de medicamentos no Brasil, utilizando modelos farmacoeconômicos (teórico e empírico). Métodos: Foram considerados como morbidades relacionadas a medicamentos os novos problemas de saúde advindos da utilização de uma farmacoterapia (por exemplo, reações adversas, dependência a medicamentos e intoxicação por overdose) e as falhas terapêuticas (por exemplo, efeito insuficiente dos medicamentos e problemas de saúde não tratados). Foram conduzidos dois estudos utilizando abordagens distintas (bottom up e top down) na coleta de dados sobre custos. O primeiro estimou, por meio da análise do tipo microcosting, os custos para resolução de Morbidades Relacionadas a Medicamentos em casos identificados no serviço de emergência de um hospital universitário. Resultados: O custo médio para tratar cada um desses pacientes é de aproximadamente R$ 2.200. Reações adversas a medicamentos, falta de adesão à farmacoterapia e problemas resultantes da administração de doses incorretas foram as causas mais prevalentes das morbidades. No segundo estudo, um modelo do tipo cost-of-illness foi traduzido e adaptado para a realidade brasileira, e então um painel com especialistas (farmacêuticos e médicos) foi realizado para estimar a proporção de pacientes que experimentam uma MRM, a proporção de MRM evitáveis e as consequências clínicas resultantes desta morbidade. A partir disto, o custo das MRM para o sistema de saúde brasileiro foi modelado, baseado em estatísticas nacionais sobre o consumo de serviços de saúde. Os especialistas julgaram as morbidades relacionadas a medicamentos como um evento bastante frequente. De acordo com esta estimativa central, as MRM seriam responsáveis por um uso considerável de recursos, podendo chegar a 23% do orçamento público anual total destinado à saúde no Brasil. Para cada real gasto com medicamentos, pelo Ministério da Saúde no Brasil, cinco reais seriam gastos para resolver as MRM. Da mesma forma foi verificado que mais da metade dos casos seriam evitáveis. Conclusão: As MRM são, de fato, um problema de ordem econômica-orçamentária, clínica e humanística para os usuários de medicamentos e para o sistema de saúde brasileiro, e que é imperiosa a criação de políticas públicas e ações capazes de evitar os danos gerados pelo uso não racional de medicamentos, garantir a segurança dos pacientes, bem como uma melhor alocação de recursos em saúde. / Introduction: Drug related morbidities and mortality (DRM) is a challenge to public health due to the consequences of ineffective and unsafe medicines use. It is well known that the DRM are common among hospitalized patients, and are preventable to some extent, but little is known about DRM outside the hospital. In Brazil, the knowledge on the subject is scarce and its economic impact is unknown. However, international studies suggest that DRM result in considerable amounts of financial resources to manage and resolve these morbidities around the world and the negative clinical consequences for those who use medicines. Aim: In this thesis, the drug related morbidities include: new medical problems arising from the pharmacotherapy (adverse effects, addiction to drugs and intoxication by overdose) and therapeutic failure (e.g. insufficient drug effect and untreated health problems). Methods: Two studies were conducted using different methodologies. The first study was a cross-sectional study, based on a microcosting analysis, where patients admitted to a teaching hospital emergency were identified in order to determine the proportion of people seeking health services due to a DRM, and, consequently, to obtain the cost for manage these patients. Results: It was observed that 14.6% of patients visiting an emergency service, do so because of a DRM and the average cost to treat each of these patients is approximately R$ 2,000. Adverse drug reactions, lack of adherence to pharmacotherapy and problems resulting from the administration of incorrect doses were the most prevalent causes of morbidity. In the second study, a cost-of-illness model was translated to portuguese and adapted, and then a panel of experts (pharmacists and physicians) was conducted to estimate the proportion of patients experiencing DRM, the proportion of preventable DRM, and the negative outcomes resulting from this morbidity. From this, the DRM cost for the Brazilian Health System was modeled, based on national statistics on the consumption of health services. Experts have judged drug-related morbidities to be a fairly frequent event. According to central estimate, the DRM would be responsible for a considerable use of resources, being able to reach 23% of the total annual public health budget in Brazil. For each real (R$ 1,00) spending on medicines, by the Brazilian Ministry of Health, five reais (R$ 5,00) would be spent to manage the DRM. Likewise, in this study it was also verified that more than half of the cases would be avoidable. In the second, a panel of experts (pharmacists and physicians) was performed to estimate the proportion of patients experiencing an DRM, DRM preventable ratio and the clinical consequences of this morbidity. From this, the cost of DRM for the Brazilian health system was modeled, based on national statistics on the consumption of health services. Conclusion: Based on these and many other results presented in this thesis, it is concluded that the DRM are indeed, an economic, clinical and humanistic issue for those who use medicines and to the Brazilian health system, and that is overriding the establishment of public policies and actions to prevent the damage caused by the non-rational use of medicines to ensure patient safety and to the best allocation of health resources.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The electricity generation in Brazil comes mainly from hydroelectric potential. Despite the importance of these sources, Brasil has several alternatives for electric power generation, such as those derived from biomass. However, the effective use of the potential of biomass is limited by the lack of information. In this context, in which the Brazilian energy matrix has heavy dependence on hydroelectric plants, whose potential disbelieve, it is necessary to take advantage of new alternatives for supplying electricity. In this sense, the objective of this study focuses on analyzing the impact of microturbines connection in the distribution system that generate energy from biogas utilization of landfill, but specifically, the landfill of Santa Maria city (Rio Grande do Sul, Brasil). Procedures for achieving this purpose consists in estimating the production of biogas in the landfill, model the microturbine and to model of the distribution system. These procedures allow the construction of the power distribution system planning scenarios, for 40 years of biogas in the landfill. After this, is done on a financial analysis of the investment return to the period of 40 years. As a result, there were positive impacts in the distribution system when the distribution generation provided energy to the grid, such as improved voltage profile in each year of simulation (2015-2055) and reduction of technical losses. Furthermore, this study have shown to be viable to different investment scenarios. When they met certain minimum annual adjustments in the price of electricity (kWh) and the price of traded carbon credits. / A geração de energia elétrica no Brasil provém essencialmente do potencial hidráulico. Apesar da importância dessa fonte, o Brasil dispõe de várias alternativas para geração de energia elétrica, como as derivadas da biomassa. Diante deste cenário, em que a matriz energética brasileira tem forte dependência de hidrelétricas, é necessário buscar novas alternativas de fornecimento de energia elétrica. Neste sentido o objetivo desta dissertação é analisar o impacto técnico e econômico da conexão de microturbinas no sistema de distribuição, gerando energia a partir do aproveitamento do biogás de aterros sanitários, mais especificamente, do aterro sanitário da cidade de Santa Maria, Rio Grande do Sul, Brasil. As etapas de análise para alcançar este objetivo consistem em estimar a produção de biogás no aterro sanitário, fazer a modelagem da microturbina, efetuar a modelagem do sistema de distribuição. Estas etapas permitem construir cenários de planejamento do sistema de distribuição, para 40 anos de produção de biogás no aterro. Após, isso, é feita uma análise de retorno financeiro do investimento para o ciclo dos 40 anos de produção de biogás. Como resultados, observaram-se impactos positivos no sistema de distribuição quando a GD forneceu energia à rede, como melhoria no perfil de tensão em todos os anos de estudo de caso (2015 a 2055) e redução de perdas técnicas. Além disso, os estudos mostraram-se viáveis para diferentes cenários de investimento, quando atendidos certos reajustes anuais mínimos do preço da energia elétrica (kWh) e do preço do crédito de carbono comercializado.

Introdução: As morbidades e mortalidade relacionadas ao uso de medicamentos (MRM) representam um desafio para a saúde pública e são consequências da utilização não efetiva e insegura dos medicamentos. Estudos internacionais mostram como as MRM afetam pacientes internados no hospital e como podem ser evitadas na maioria dos casos. Entretanto, pouco é conhecido sobre as MRM na prática ambulatorial. Estas pesquisas têm abordado as consequências clínicas negativas para os usuários de medicamentos e sugerem que vultosas somas de recursos financeiros são utilizadas para manejar e resolver estas morbidades ao redor do mundo. Já no Brasil, o conhecimento sobre as MRM é escasso em ambas perspectivas e o seu impacto econômico é desconhecido. Objetivo: O propósito desta Tese foi obter uma estimativa sobre os gastos com morbidade e mortalidade associadas ao uso de medicamentos no Brasil, utilizando modelos farmacoeconômicos (teórico e empírico). Métodos: Foram considerados como morbidades relacionadas a medicamentos os novos problemas de saúde advindos da utilização de uma farmacoterapia (por exemplo, reações adversas, dependência a medicamentos e intoxicação por overdose) e as falhas terapêuticas (por exemplo, efeito insuficiente dos medicamentos e problemas de saúde não tratados). Foram conduzidos dois estudos utilizando abordagens distintas (bottom up e top down) na coleta de dados sobre custos. O primeiro estimou, por meio da análise do tipo microcosting, os custos para resolução de Morbidades Relacionadas a Medicamentos em casos identificados no serviço de emergência de um hospital universitário. Resultados: O custo médio para tratar cada um desses pacientes é de aproximadamente R$ 2.200. Reações adversas a medicamentos, falta de adesão à farmacoterapia e problemas resultantes da administração de doses incorretas foram as causas mais prevalentes das morbidades. No segundo estudo, um modelo do tipo cost-of-illness foi traduzido e adaptado para a realidade brasileira, e então um painel com especialistas (farmacêuticos e médicos) foi realizado para estimar a proporção de pacientes que experimentam uma MRM, a proporção de MRM evitáveis e as consequências clínicas resultantes desta morbidade. A partir disto, o custo das MRM para o sistema de saúde brasileiro foi modelado, baseado em estatísticas nacionais sobre o consumo de serviços de saúde. Os especialistas julgaram as morbidades relacionadas a medicamentos como um evento bastante frequente. De acordo com esta estimativa central, as MRM seriam responsáveis por um uso considerável de recursos, podendo chegar a 23% do orçamento público anual total destinado à saúde no Brasil. Para cada real gasto com medicamentos, pelo Ministério da Saúde no Brasil, cinco reais seriam gastos para resolver as MRM. Da mesma forma foi verificado que mais da metade dos casos seriam evitáveis. Conclusão: As MRM são, de fato, um problema de ordem econômica-orçamentária, clínica e humanística para os usuários de medicamentos e para o sistema de saúde brasileiro, e que é imperiosa a criação de políticas públicas e ações capazes de evitar os danos gerados pelo uso não racional de medicamentos, garantir a segurança dos pacientes, bem como uma melhor alocação de recursos em saúde. / Introduction: Drug related morbidities and mortality (DRM) is a challenge to public health due to the consequences of ineffective and unsafe medicines use. It is well known that the DRM are common among hospitalized patients, and are preventable to some extent, but little is known about DRM outside the hospital. In Brazil, the knowledge on the subject is scarce and its economic impact is unknown. However, international studies suggest that DRM result in considerable amounts of financial resources to manage and resolve these morbidities around the world and the negative clinical consequences for those who use medicines. Aim: In this thesis, the drug related morbidities include: new medical problems arising from the pharmacotherapy (adverse effects, addiction to drugs and intoxication by overdose) and therapeutic failure (e.g. insufficient drug effect and untreated health problems). Methods: Two studies were conducted using different methodologies. The first study was a cross-sectional study, based on a microcosting analysis, where patients admitted to a teaching hospital emergency were identified in order to determine the proportion of people seeking health services due to a DRM, and, consequently, to obtain the cost for manage these patients. Results: It was observed that 14.6% of patients visiting an emergency service, do so because of a DRM and the average cost to treat each of these patients is approximately R$ 2,000. Adverse drug reactions, lack of adherence to pharmacotherapy and problems resulting from the administration of incorrect doses were the most prevalent causes of morbidity. In the second study, a cost-of-illness model was translated to portuguese and adapted, and then a panel of experts (pharmacists and physicians) was conducted to estimate the proportion of patients experiencing DRM, the proportion of preventable DRM, and the negative outcomes resulting from this morbidity. From this, the DRM cost for the Brazilian Health System was modeled, based on national statistics on the consumption of health services. Experts have judged drug-related morbidities to be a fairly frequent event. According to central estimate, the DRM would be responsible for a considerable use of resources, being able to reach 23% of the total annual public health budget in Brazil. For each real (R$ 1,00) spending on medicines, by the Brazilian Ministry of Health, five reais (R$ 5,00) would be spent to manage the DRM. Likewise, in this study it was also verified that more than half of the cases would be avoidable. In the second, a panel of experts (pharmacists and physicians) was performed to estimate the proportion of patients experiencing an DRM, DRM preventable ratio and the clinical consequences of this morbidity. From this, the cost of DRM for the Brazilian health system was modeled, based on national statistics on the consumption of health services. Conclusion: Based on these and many other results presented in this thesis, it is concluded that the DRM are indeed, an economic, clinical and humanistic issue for those who use medicines and to the Brazilian health system, and that is overriding the establishment of public policies and actions to prevent the damage caused by the non-rational use of medicines to ensure patient safety and to the best allocation of health resources.

O Novo Código Florestal brasileiro se tornou em 25 de maio de 2012 o principal conjunto normativo ambiental instituído pela Lei n° 12.651/2012, que regulamenta a exploração, conservação e recuperação da vegetação nativa em nível nacional. Contudo tal legislação enfrenta Ações Diretas de Inconstitucionalidade (ADIs), as quais apontam prejuízos ambientais por causa da flexibilidade das novas regras relacionadas às áreas de preservação permanente, à redução da reserva legal e também à anistia para àqueles enquadrados por degradação ambiental antes de 22 de julho de 2008. O objetivo desta pesquisa foi comparar os impactos econômicos de alterações do Novo Código Florestal, sobre os setores econômicos e regiões do Brasil, considerando três cenários possíveis. Para tanto, foram utilizados dados de cenários específicos gerados pelo modelo GLOBIOM-Brasil: 1) O primeiro cenário traz restrições no uso da terra em caso da utilização parcial do mecanismo de Cotas de Reserva Ambiental (CRA), como forma de compensação do déficit de reserva legal, apenas na agricultura (excluindo pecuaristas); 2) o segundo cenário incorpora restrições no uso no solo em caso da desaprovação do mecanismo Cotas de Reserva Ambiental (CRA), ou seja, desconsidera-se totalmente esse mecanismo de compensação; e 3) no terceiro cenário a restrição do uso da terra está relacionada a desconsideração da anistia das multas e sanções concedida pela Lei 12.651/2012. Esses dados foram integrados à base do Modelo TERM-BR. A metodologia integra dois modelos: GLOBIOM-Brasil e TERM-BR. Os resultados mostraram que o valor dos agregados macroeconômicos, no período acumulado de 2010 a 2030, comparado com a linha de base, houve queda no PIB de 0,12%, 0,14% e 051%, nos cenários 1, 2 e 3, respectivamente. Como também houve queda no Consumo, Gastos do Governo e Importação (vol.) com retração de 0,1% (cenários 1 e 2) e cerca de 0,5% (cenário 3), o Investimento se reduz em 0,8%, 0,8% e 3,1%, nos respectivos cenários 1,2 e 3. A queda percentual no salário real é ainda maior do que no consumo, onde houve redução de 0,3% (cenário 1 e 2) e 1,2% (cenário 3). As exportações aumentam em 0,4% no primeiro e no segundo cenário, enquanto no terceiro cenário o incremento chega a 1,9%. A retração no mercado interno, pressiona os setores agroexportadores para comercialização no mercado internacional. No primeiro cenário, a região mais afetada economicamente foi a do Pará-TO com queda de 2,5% no PIB regional. No segundo cenário o estado do Mato Grosso apresentou maior queda no PIB, em 4,5%. No terceiro cenário, Goiás foi o mais afetado, com queda de 4,3% no PIB, tais resultados foram ocasionados por perda de área de pastagem e de soja, principalmente. Além disso, os resultados mostram que a soja e a criação de bovinos são as atividades mais impactadas negativamente por tais mudanças na política ambiental. / New Forest Code of Brazil became the main environmental regulatory on May 25, 2012, established by Law No. 12.651 / 2012, which regulates exploration, conservation and recovery of native vegetation nationwide. However, this legislation faces Direct Unconstitutionality Actions (DUIs), which point to environmental damages because of the flexibility of the new rules related to permanent preservation areas, reduction of legal reserve and amnesty for those framed by environmental degradation before July 22 of 2008. The objective of this research was to compare the economic impacts of changes in the New Forest Code on economic sectors and regions of Brazil, considering three possible scenarios. For that purpose, we used data from specific scenarios of the GLOBIOM-Brazil model: 1) the first scenario restricts land use in case of partial use of the Mechanism of Environmental Reserves Quotas (CRA in Portuguese) in order to compensate for the legal reserve deficit, only in agriculture (excluding livestock farmers); 2) the second scenario restricts land use in case of disapproval of the Mechanism of Environmental Reserves Quotas mechanism, that is, the mechanism of compensation is totally ignored; and 3) in the third scenario, land use restriction is related to disregarding amnesty of fines and sanctions granted by Law No. 12.651 / 2012. These data were integrated to the base of the TERM-BR model. The methodology integrates two models: GLOBIOM-Brazil and TERM-BR. The results showed that the value of the macroeconomic aggregates, in the accumulated period from 2010 to 2030, compared to the baseline, showed a GDP drop of 0.12%, 0.14% and 051% in scenarios 1, 2 and 3 , respectively. As there was also a decline in consumption, government and importations (vol.) , which decreased of 0.1% (scenarios 1 and 2) and around 0.5% (scenario 3), investment decreased by 0.8% , 0.8% and 3.1% in the respective scenarios 1,2 and 3. The percentage decrease in real salary higher than in consumption showed a reduction of 0.3% (scenarios 1 and 2) and 1, 2% (scenario 3). Exports increased by 0.4% in scenarios 1 and 2, while in scenario 3, the increase is close to 1.9%. The downturn in the domestic market pressures the agro-export sectors for commercialization in the international market. In the first scenario, the region most affected economically was Pará-TO, with a drop of 2.5% in regional GDP. In scenario 2, the state of Mato Grosso showed the greatest GDP drop, at 4.5%. In scenario 3, Goiás was mostly affected, with a fall of 4.3% in GDP, such results were caused by loss of grazing area and soybean, mainly. In addition, it was observed that soybean and cattle raising are the activities most negatively impacted by such changes in environmental policy.

The aim of the thesis is to evaluate the economic impact of the Olympic Park Lipno. First of all, it describes the so-called mega sport events and their impacts, especially the economic ones. Furthermore, the ex-ante and ex-post studies and crowding out effect are characterised in the research. In addition, two analyzes which are described in detail in the thesis were prepared by KPMG. The research method is a questionnaire survey with all information gained at the Olympic Park Lipno. The questionnaires and the collection of secondary data allowed us to proceed to comparison of the researched studies and, in particular, to the calculation of the economic impact.

The erection of tollgates along the N1 freeway has triggered a great deal of interest. As a result of the toll fees, traffic has been diverted to alternative roads. This study investigates how traffic diverted from the toll road affect the welfare of users of the alternative road. The literature review provides a theoretical framework of economic impact assessment and road pricing. Furthermore, the literature study reviews previous studies of a similar nature and compare them with the findings of this study. There is no conclusive evidence that diversion of traffic from the N1 causes congestion on the R101 and has a negative impact on the economy of the region. On the contrary, evidence suggests that there was an initial diversion of traffic when the toll came into operation but that is slowly filtered back after six months. In the application of the RED model, economic benefits are derived from user benefits, which is a function of savings in VOC’s and time of normal and generated traffic on a road or saving due to an improvement in road safety, resulting from improved roads. A decrease in traffic has a measurable effect on vehicle travel speeds and travel time only when the roads are significantly congested. In the case of scenario 1 (including diversion), frequent maintenance needs to be performed under increased traffic. Increased traffic due to “diverted traffic” causes congestion in accidents and travelling time, which is a cost to the economy. Under scenario 2 (excluding diversion), it is assumed that ADT will return to normal. Due to lower levels of congestion and travelling times would be faster, while maintenance costs and accident rates would decrease. Scenario 2 is selected as being economically the most feasible option. It is clear that the R101 cannot cope with the current levels of traffic and congestion. One can speculate about the causes of the congestion but in order to derive at a solution to the problem more research needs to be done on the cause of the congestion in order to resolve the problem. / Dissertation (Magister Commercii)--University of Pretoria, 2007. / Economics / unrestricted

The economic situation of the company Prague International Marathon, s.r.o. is the main objective of this Diploma Thesis. To be more accurate, it particularly is the application of methods and tools of financial analysis together with analysis of revenue and costs of the company. When implementing previous methods and tools of economic analysis, we will be able to assess the economic health of the company. This analysis is primarily focused on horizontal and vertical analysis of assets and liabilities. It also focuses on ratio indicators. Following section of the Thesis deals with economic analysis of earnings and costs. The final task is to analyze the economical impact of organizing running actions in the Czech Republic. This economical impact will be compared with similar actions taking place in Germany, especially in Berlin.

The master thesis is focused on evaluation of economic benefits that are generated by tourism activities in the destination Kadaň. The evaluation uses methodological framework of the tourism satellite account regionalization and local survey. Main attention is focused on quantifying the impacts on regional employment and business environment. The conclusion is based on the theory of destination lifecycle.

京都大学 / 新制・課程博士 / 博士(情報学) / 甲第23316号 / 情博第752号 / 新制||情||128(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 多々納 裕一, 教授 畑山 満則, 准教授 大西 正光 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DGAM

Oliver Tambo Institute of Governance and Policy Studies / MPM