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O câncer de colo de útero (CCU) é um dos mais danosos que afetam as mulheres, especialmente em países em desenvolvimento, onde os programas de prevenção (baseados no exame de Papanicolaou) não se mostram efetivos. Vacinas contra o HPV foram disponibilizadas em 2007 como prevenção primária do CCU. Apresentam boa eficácia e segurança, porém um elevado custo para sua incorporação. O objetivo desta dissertação é avaliar a incidência de câncer de colo de útero no estado de Roraima, seu impacto econômico, e o perfil sócio-econômico das portadoras de CCU tratada no SUS, além de realizar análises de custo-efetividade e custo-utilidade da inclusão da vacinação para o HPV aos programas preventivos vigentes. A dissertação é composta por 2 ensaios cujo tema unificador é a análise econômica de estratégias de combate ao CCU. No primeiro ensaio, todos os exames histopatológicos e citológicos emitidos em Roraima em 2009 foram revisados, juntamente com os prontuários médicos de todas as pacientes portadoras de CCU. Todos os procedimentos terapêuticos e diagnósticos realizados em 2009 em portadoras de CCU foram registrados. Prospectivamente foram entrevistadas as pacientes portadoras de CCU abordando tópicos sócio-econômicos. Foram registrados 90 casos de CCU em Roraima em 2009. A incidência correspondeu a 46,2 casos novos por 100.000 mulheres, a maior do Brasil. As portadoras do CCU demonstram perfil econômico desfavorável, exclusão social, e baixo conhecimento e adesão precária aos programas preventivos de saúde feminina. O impacto anual do CCU para gestão em saúde de Roraima é superior a R$8 mil por caso. Este ensaio ressalta a inequidade de acesso aos programas preventivos em Roraima, excluindo da cobertura de rastreio o subgrupo que mais se beneficiaria, e gerando custos elevados. O segundo ensaio realiza avaliações econômicas da incorporação da vacina para o HPV para o estado de Roraima. Foi desenvolvido um modelo de coorte de Markov como instrumento analítico de simulação da história natural do HPV até a progressão para CCU, levando em consideração os programas preventivos. As probabilidades de transição foram baseadas preferencialmente em dados empíricos locais e nacionais. Após calibração satisfatória e considerando valores de caso-base, a adição a vacinação para HPV reduziria em 35% a incidência de CCU, em cenário de realização de 3 testes de Papanicolaou ao longo da vida. A razão incremental de custo-efetividade foi de R$ 2.556 para cada ano de vida ajustado pela qualidade (AVAQ) poupado. As análises de sensibilidade confirmam a robustez deste resultado. A vacinação possui perfil favorável do ponto de vista de custo-utilidade, e sua inclusão no calendário vacinal resultaria em redução substancial da incidência e mortalidade por CCU em Roraima. / Invasive cervical cancer (ICC) is one of the most damaging that affect women, especially in developing countries, where preventive programs (based on the Pap smear) haven’t achieved effectiveness. HPV vaccines have recently been proposed as primary prevention of ICC. They show good efficacy and safety, but a high cost for its acquisition. Objectives: The objective of this dissertation is to evaluate the incidence of ICC in Roraima, its economic impact, and the socioeconomic profile of ICC carriers assisted in the public health system, and to perform a costeffectiveness and cost-utility analysis of adding HPV vaccination to current preventive programs. In the first essay, all histopathologic and cytologic reports issued in Roraima in 2009 were reviewed, along with the medical records of all patients diagnosed with ICC. All therapeutic and diagnostic procedures performed in 2009 in women with ICC cervix carcinoma were recorded. These patients were argued prospectively, addressing socio-economic topics. We registered 90 cases of cervical cancer in Roraima in 2009. The incidence corresponded to 46.2 new cases per 100,000 women. Carriers of the ICC showed unfavorable economic profile, social exclusion, deficient knowledge on ICC prevention and low adherence to the screening preventive programs. The annual impact of the ICC in Roraima is over R$ 8,000 per case. This essay highlights the inequity of access to preventive programs in Roraima, that excludes the subgroup of the population who would mostly benefit from screening, resulting in elevated costs. The second essay conducted economic evaluations of the incorporation of HPV vaccine to preventive programs in Roraima. A Markov cohort model was developed as an analytic tool to simulate the natural history of HPV and its progress to ICC, considering the current preventive programs. Transition probabilities were based mainly on empirical data of local and national studies. After satisfactory calibration values and considering the base case, the addition of HPV vaccination would reduce by 35% the incidence of ICC, in a scenario of three Pap tests throughout life. The incremental ratio of cost-effectiveness was R$ 2,556 for each year of quality-adjusted life (QALY) saved. The sensitivity analysis confirms the robustness of this result. Vaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in substantial reduction in incidence and mortality of ICC in Roraima.

O câncer de colo de útero (CCU) é um dos mais danosos que afetam as mulheres, especialmente em países em desenvolvimento, onde os programas de prevenção (baseados no exame de Papanicolaou) não se mostram efetivos. Vacinas contra o HPV foram disponibilizadas em 2007 como prevenção primária do CCU. Apresentam boa eficácia e segurança, porém um elevado custo para sua incorporação. O objetivo desta dissertação é avaliar a incidência de câncer de colo de útero no estado de Roraima, seu impacto econômico, e o perfil sócio-econômico das portadoras de CCU tratada no SUS, além de realizar análises de custo-efetividade e custo-utilidade da inclusão da vacinação para o HPV aos programas preventivos vigentes. A dissertação é composta por 2 ensaios cujo tema unificador é a análise econômica de estratégias de combate ao CCU. No primeiro ensaio, todos os exames histopatológicos e citológicos emitidos em Roraima em 2009 foram revisados, juntamente com os prontuários médicos de todas as pacientes portadoras de CCU. Todos os procedimentos terapêuticos e diagnósticos realizados em 2009 em portadoras de CCU foram registrados. Prospectivamente foram entrevistadas as pacientes portadoras de CCU abordando tópicos sócio-econômicos. Foram registrados 90 casos de CCU em Roraima em 2009. A incidência correspondeu a 46,2 casos novos por 100.000 mulheres, a maior do Brasil. As portadoras do CCU demonstram perfil econômico desfavorável, exclusão social, e baixo conhecimento e adesão precária aos programas preventivos de saúde feminina. O impacto anual do CCU para gestão em saúde de Roraima é superior a R$8 mil por caso. Este ensaio ressalta a inequidade de acesso aos programas preventivos em Roraima, excluindo da cobertura de rastreio o subgrupo que mais se beneficiaria, e gerando custos elevados. O segundo ensaio realiza avaliações econômicas da incorporação da vacina para o HPV para o estado de Roraima. Foi desenvolvido um modelo de coorte de Markov como instrumento analítico de simulação da história natural do HPV até a progressão para CCU, levando em consideração os programas preventivos. As probabilidades de transição foram baseadas preferencialmente em dados empíricos locais e nacionais. Após calibração satisfatória e considerando valores de caso-base, a adição a vacinação para HPV reduziria em 35% a incidência de CCU, em cenário de realização de 3 testes de Papanicolaou ao longo da vida. A razão incremental de custo-efetividade foi de R$ 2.556 para cada ano de vida ajustado pela qualidade (AVAQ) poupado. As análises de sensibilidade confirmam a robustez deste resultado. A vacinação possui perfil favorável do ponto de vista de custo-utilidade, e sua inclusão no calendário vacinal resultaria em redução substancial da incidência e mortalidade por CCU em Roraima. / Invasive cervical cancer (ICC) is one of the most damaging that affect women, especially in developing countries, where preventive programs (based on the Pap smear) haven’t achieved effectiveness. HPV vaccines have recently been proposed as primary prevention of ICC. They show good efficacy and safety, but a high cost for its acquisition. Objectives: The objective of this dissertation is to evaluate the incidence of ICC in Roraima, its economic impact, and the socioeconomic profile of ICC carriers assisted in the public health system, and to perform a costeffectiveness and cost-utility analysis of adding HPV vaccination to current preventive programs. In the first essay, all histopathologic and cytologic reports issued in Roraima in 2009 were reviewed, along with the medical records of all patients diagnosed with ICC. All therapeutic and diagnostic procedures performed in 2009 in women with ICC cervix carcinoma were recorded. These patients were argued prospectively, addressing socio-economic topics. We registered 90 cases of cervical cancer in Roraima in 2009. The incidence corresponded to 46.2 new cases per 100,000 women. Carriers of the ICC showed unfavorable economic profile, social exclusion, deficient knowledge on ICC prevention and low adherence to the screening preventive programs. The annual impact of the ICC in Roraima is over R$ 8,000 per case. This essay highlights the inequity of access to preventive programs in Roraima, that excludes the subgroup of the population who would mostly benefit from screening, resulting in elevated costs. The second essay conducted economic evaluations of the incorporation of HPV vaccine to preventive programs in Roraima. A Markov cohort model was developed as an analytic tool to simulate the natural history of HPV and its progress to ICC, considering the current preventive programs. Transition probabilities were based mainly on empirical data of local and national studies. After satisfactory calibration values and considering the base case, the addition of HPV vaccination would reduce by 35% the incidence of ICC, in a scenario of three Pap tests throughout life. The incremental ratio of cost-effectiveness was R$ 2,556 for each year of quality-adjusted life (QALY) saved. The sensitivity analysis confirms the robustness of this result. Vaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in substantial reduction in incidence and mortality of ICC in Roraima.

Made available in DSpace on 2014-10-09T12:42:19Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:59:55Z (GMT). No. of bitstreams: 0 / O hidrogênio pode ser considerado um importante e promissor vetor energético, podendo ser utilizado para substituir os combustíveis fósseis no setor de transportes por meio de células a combustível. Existem muitos métodos de se produzir hidrogênio. Estes métodos incluem a reforma de gás metano, a eletrólise e processos termo químicos. Uma grande quantidade de energia é necessária para se produzir hidrogênio. Em muitos processos de produção de hidrogênio, a energia de entrada necessária é na forma de calor ou eletricidade. O objetivo deste trabalho é analisar a viabilidade da produção de hidrogênio eletrolítico, utilizando-se energia disponível do sistema interligado nacional da cidade de São Paulo. Para atingir este objetivo estudou-se o sistema elétrico brasileiro, a tecnologia de produção, armazenamento e transporte do hidrogênio, analisando-se os custos e a avaliação ambiental de cada item. Calculou-se as externalidades negativas da poluição ambiental causada pela frota de ônibus movidos a diesel e por meio das análises e estimativas mostrou-se a viabilidade de substituição dos ônibus a diesel por ônibus a hidrogênio e a consequente melhora na qualidade socioambiental da população da cidade de São Paulo. / Tese (Doutoramento) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

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Coastal tourism is one of the most important way of leisure and entertainment in the world, which brings impact in varying degrees to the tourism destination. These effects relate to economic, social, and environmental aspects. With the concept of sustainability being widely used, sustainable tourism has received more attention. However, most studies focus on the tourism impact on the coastal environment, while the social and economic aspects were sparse explorations. Therefore, this research applies the qualitative method to explore the social and economic impact of tourism on the coastal city, Kalmar. Furthermore, the perspective of residents and business owners is the main way to reflect these effects. According to the results of the study, the development of the tourism industry will indeed bring some impact to the coastal city on economy and society. However, due to differences of cultural background and actual situation, these effects are not always the same. For example, for the economic impact of tourism business, the impact on the hotel is more noticeable than the impact on restaurants and bars.

Philosophiae Doctor - PhD / The income and employment multiplier effects of tourism- The case of Rwanda. A. NTIBANYURWA PhD Thesis, Department of Economics, University of the Western Cape. The growing popularity of developing countries as tourist destinations in recent years has stimulated a considerable body of research on the developmental benefits inherent in tourism. Developing countries have been attracting tourists mainly due to their natural resource endowments, considered a vital determinant in this newly-found source of their comparative advantage. After accounting for all the explicit and hidden costs linked to this natural resource-based tourism, the sustainable expansion of the tourism sector is claimed to be contributing substantially to economic growth. Studies to date have investigated the rising share of tourism in macroeconomic output, but have paid limited attention to the economic mechanisms through which tourism supposedly leads to broader development. This study seeks to contribute to filling this gap in our knowledge of the economic dynamics associated with tourism. More specifically, the goal is to shed light on the channels through which tourism contributes to economic growth and to derive tourism income and employment multipliers to estimate its developmental benefits for Rwanda. Our refined multipliers to capture the total effects of tourism to the economy confirm that through its powerful inter-sectoral linkages, tourism improves the economic wealth of many developing countries including Rwanda. Deeper analysis of the macroeconomic consequences of the expansion of the service sector however suggests that, under some conditions, this could exhibit “Dutch Disease” effects. Tourism generates substantial foreign earnings and its development is strongly correlated with the shrinkage of the traditional primary

To address the scale mountain pine beetle (MPB) outbreak in British Columbia, salvage has become fully integrated with timber supply strategies. The objective of this thesis is to assess the economic impact of different salvage strategies depending on different attack levels, decay rates, and stakeholder discount rates. The study area is located in N.E. British Columbia where the MPB has not yet reached its peak and where susceptible to attack stands account for 40% of the area. Salvage strategies were modelled with a timber supply model (Woodstock) which uses a linear programming type II optimization approach. Performance of the model was assessed over a range of indicators such as NPV, profit, salvage proportion, species composition, inventory levels, and non-recoverable volume. Sensitivity analyses were conducted on harvest flow, discount rate, and ending inventory. The model was very sensitive to the intensity of attack and less sensitive to the decay level. The high level of attack resulted in large volume losses, mostly as un-salvaged inventory. Although allowable annual cut (AAC) uplifts have an economic benefit, they do not necessarily maximize the salvage of pine. Non-pine species are an important component of the salvage and these species are also essential for the future timber supply. If the objective is to ensure quality and quantity of the future forest, policies have to complement AAC uplifts by strongly encouraging the salvage of mainly pine-leading stands and management options that minimize the “by-catch” of non-pine species and minimize destruction of advanced regeneration during salvage. However, this has an opportunity cost for the private industry where the objective is to maximize profit. If the salvage strategy focuses on decreasing the impact on cash flows, achieving desirable ending inventory levels, avoiding salvage of stands after shelf-life, and reducing impact on non-attack species, then the current harvest level will likely lead to a mid-term timber supply fall-down. Using the fibre for bioenergy production is an alternative if managing for bioenergy can be integrated into harvest operations. However, unlike mill residues, the bioenergy supply has to fully account for harvest and transportation costs of dead wood to the mill. / Forestry, Faculty of / Graduate

The South African wine industry faces unique challenges in the socio-economic development of its farm labourers due to its historical context and development over the past three centuries. A long history of malpractice, a lasting paternalistic mentality, and only partial compliance to regulations to reduce inequality and improve livelihoods for farm labourers hinders the success of industry-wide transformation. Despite studies regarding the current state of living and working conditions in the wine industry and types of socio-economic development needed for successful transformation, little research has been done to address whether these initiatives are creating a lasting impact on the well-being of labourers. Research on current intervention strategies aimed at empowering labourers must take into account the origin of wine in the Cape region, the legacy of Apartheid, and the current state of socio-economic inequality amongst wine industry workers. The purpose of this research is to provide a better understanding of how and to what degree initiatives and programmes designed for socio-economic development are actually making an impact within the industry. The central research question asks: “to what extent has socio-economic development initiatives aimed at the transformation of wine farm labourers influenced perceptions of well-being?” This research combines both document analysis and qualitative comparative case study methods in assessing the impact these initiatives have had on labourers’ perceptions and attitudes towards personal development and a better standard of living. At the end of the study, the researcher wants to know how the labourers perceive socio-economic initiatives; do they actually believe themselves has having gained increased levels of respect, dignity, and equality, and have these perceptions been impacted by current socio-economic initiatives?.