Magistro baigiamajame darbe išanalizuotas ir įvertintas trijų pažeidžiamiausių socialinės rizikos asmenų grupių, kurios kelia didelę grėsmę visuomenei, teisinės informacijos poreikis. Tai yra asmenys grįžę iš įkalinimo įstaigų ir asmenys priklausomi nuo alkoholio ar narkotikų. Šioms socialinės rizikos grupėms teisinės informacijos poreikių ugdymas ypatingas tuo, kad be teisės žinių jie nesugeba sąmoningai elgtis, suprasti keliamus reikalavimus, pasižymi didesne tikimybe patekti į socialinę atskirtį ir linkę nusikalsti. Remiantis atliktų tyrimų rezultatais daroma išvada, kad analizuojamų socialinės rizikos asmenų teisinės informacijos poreikis yra per mažas, jie nelinkę ieškoti teisinių žinių, nes mano, jog tai jiems yra nebūtina. Dauguma jų yra pasyvūs, jie patys nesuinteresuoti nieko daryti. Šios rizikos grupės išreikšta tendencija kaltinti aplink esančius kitus žmones, ignoravimas teisinės pagalbos yra pagrindinės priežastys dėl kurių jie ja nesidomi. Socialiniai rizikai priklausantys asmenys aktyviai vengia sužinoti bei susitikti su teikiančiais teisinę informaciją asmenimis, kas ir lemia jų teisinių žinių vakuumą. Jie nenoriai dalyvauja siūlomose priemonėse ir programose, jie priešinasi įsisavinant teisinius klausimus ir teisinėmis žiniomis paisyti teisės normas. Atlikto tyrimo duomenys parodė, kad teisinės informacijos poreikis turi būti ugdomas. Tai yra kompleksinis procesas, formuojamas valstybės ir visuomeninių ugdymo institucijų pajėgomis, jis turi būti skatinamas... [toliau žr. visą tekstą] / Need for legal information of three most vulnerable groups of people at social risk that endanger the society, was analyzed and evaluated in the Final work of Master. They are the people, those returned from the places of confinement and drug and alcohol addicts. The cultivation of the need for legal information for these groups of the people at social risk is special because without legal knowledge they are not able to act deliberately, understand upraised requirements and have a bigger possibility to get in social disjuncture and make a crime. Pursuant to the results of performed analysis, we can conclude that the need for legal information of the analyzed people at social risk is too low; they do not search for legal knowledge, because they think that it is not important. Most of them are passive; they are not interested in doing anything by themselves. There is expressed tendency of this group at risk to the people around, disregard of legal help and it is the main reasons why they are not interested in it. The people at social risk actively avoid learning and meeting people that providing legal information, which determined vacuum in their legal knowledge. They unwillingly participate in offered measures and programs; they resist assimilation of legal questions and observance of legal norms with help of legal knowledge. The data of performed test showed that the need for legal information should be cultivated. It is a complex process, formed by the attempts of state and... [to full text]

Le propos de cette tâche est d'établir une méthode de sélection des experts dans deux champs particuliers : celui du degré de responsabilité pénale des " malades mentaux " et celui des déclarations d'abus sexuels d'enfants.Il est d'usage dans les cours de justice de sélectionner les experts ayant simplement un diplôme de psychologie ou de psychiatrie par nomination ou cooptation.Nous utilisons un modèle combiné.Le premier concerne la sélection des meilleurs par deux traits majeurs : la Discrimination et la Cohérence.Le second concerne la validité de la crédibilité d'enfants entre cinq et douze ans à propos de déclarations d'abus sexuels.La mesure de la performance sélectionne les professionnels les plus efficients. Puis, nous avons comparé ces résultats à ceux d'autres groupes d'une population générale dans un souci démocratique. Nous avons constaté par exemple que les professeurs d'Université et parfois d'autres praticiens (en droit, psychologie ou psychiatrie) étaient capables d'avoir des performances aussi bonnes que celles des experts professionnels. L'usage d'un étalon peut améliorer conséquemment la performance de tous. Mais une certaine différence persiste entre professeurs et autres catégories à l'avantage des premiers nommés. Nous pouvons subsumer ce résultat par une maxime disant : " Einstein, bien que n'étant que prix Nobel de physique est éventuellement un meilleur mathématicien qu'un professeur agrégé de mathématiques ". On peut affirmer que la Discrimination et la Cohérence aidées par un étalon, pour une intelligence sélectionnée et générale, sont souvent plus efficientes que celles d'une intelligence seulement spécialisée.

Un système documentaire est modélisé par trois fonctions : la fonction d'indexation dont on étudie les hypothèses permettant l'indexation automatique. Une fonction de traduction des questions de l'utilisateur qui permet de définir la qualité de l'interface homme-système. Une fonction de pertinence qui permet de classer les documents en fonction des besoins documentaires de l'utilisateur. On étudie dans ce cadre le modèle booléen, le modèle vectoriel, et le modèle probabiliste. On évalue les perspectives offertes par le modèle hypertexte et l'approche connexionniste en informatique documentaire. Une application pratique est étudiée : la réalisation, suivant un modèle booléen de l'interface utilisateur du catalogue de la bibliothèque scientifique de l'université de Caen. On évalue ensuite les axes de recherche nouveaux en informatique documentaire au travers de trois axes de travail : les systèmes experts, l'auto-apprentissage et les modèles de représentation. La perspective des anté-serveurs intelligents est présentée, et une liste des fonctionnalités nécessaires au succès de ce type d'intermédiaire est établie.

Kultūros paveldas yra kiekvienos šalies skirtingų visuomenės grupių, tautinių bendrijų, gyvenančių joje, istorinės raidos ir kūrybos rezultatas, visuomenės evoliucijos liudytojas. Pagal išlikusias materialines ir dvasines vertybes, galime daug pasakyti apie tos šalies ir joje gyvenančių tautų istorinę raidą, pasiekimus ir praradimus. Išsaugoti kultūros paveldą, kurio visumą sudaro ir dar neištirta bei nesaugoma paveldo dalis, yra vienas iš svarbiausių Lietuvos Respublikos paveldosaugos sistemos uždavinių. Kultūros paveldo įvairovė bei savitumas pasakoja apie šalies istorinę praeitį, kelia valstybės ir tautos pasididžiavimą, ugdo naujos kartos patriotizmą. Šiame darbe galime išskirti kelias problemas: 1) Išvežamų į užsienį kultūros vertybių kontrolės skyriaus veiklos įvertinimas paveldosaugos sistemoje. Įvertindami Išvežamų į užsienį kultūros vertybių kontrolės skyriaus veiklą paveldosaugos sistemoje, apžvelgsime šio skyriau nuveiktą darbą nuo 1990 iki 2005 metų.; 2) kilnojamųjų kultūros vertybių išsaugojimas Lietuvos kultūros paveldui. Šio darbo aktualumą nulemia poreikis ne tik pristatyti Išvežamų į užsienį kultūros vertybių kontrolės skyriaus veiklą, bet ir išaiškinti atliekamo darbo vertes bei svarbą didesniajai Lietuvos visuomenės daliai, tuo pačiu išsaugant kultūros vertybes Lietuvos kultūrai. Tam, kad įvyktų įpaveldinimo procesas, reikia, kad jos būtų pripažintos ir vertintinos ne tik specialistų, bet ir visos visuomenės. Atlikus darbą galime daryti tokias išvadas... [toliau žr. visą tekstą] / Cultural heritage bears witness to the evolution of society and is the result of the work and historical development of the discrete groups and ethnic communities living in each country. We can tell much about the historical development, achievements and losses of a country and the nations living within it by examining surviving material and cultural values. One of the key tasks for the heritage protection system of the Republic of Lithuania is the protection of the cultural heritage, which also includes that portion of the heritage as yet unexamined and unprotected. The diversity and individuality of its cultural heritage tells of the country’s historical past, instills pride in the nation and state and teaches the upcoming generation patriotism. Several problems are addressed in this work: 1) the assessment of the activity of the Division for Export of Cultural Values within the Lithuanian heritage protection system, considered from 1990 to 2005; 2) The conservation for the Lithuanian cultural heritage of movable cultural values. This work is made topical not just by the need to present the work of the Division for Export Control of Cultural Values, but also to explain the value and importance of the work performed there for the broader Lithuanian society, at the same time protecting cultural values for Lithuanian culture. In order for the process of transmitting heritage to take place, these cultural values must be recognized and appreciated by society as a whole, and not... [to full text]

SAFO (Sistema Agregador de Ferramentas de Operação de Rede) é um ambiente aberto e integrado que visa auxiliar na tarefa de gerenciamento de redes. O sistema e o resultado de um estudo de vários utilitários já existentes e a seleção de um conjunto mínimo necessário para a realização de monitoramento e manipulação dos componentes da rede. Os utilitários selecionadas foram integradas num típico ambiente, onde o usuário interage com o sistema através de uma interface gráfica baseada em janelas, facilitando o uso dos utilitários disponíveis. O grande número de parâmetros inerentes a cada utilitário podem inibir ou reduzir seu uso, por isso foi implementado um sistema de help on-line para todos os utilitários com o objetivo de auxiliar na sua utilização. Muitas vezes, as mensagens decorrentes da execução dos utilitários são de difícil interpretação ou são desconhecidas, o que torna o seu resultado praticamente inútil. Para tentar minimizar este problema, o SAFO oferece uma Função Assistente, que auxilia nesta interpretação interagindo com um Banco de Recomendações, onde e apresentada a mensagem resultante da execução do utilitário, as prováveis causas que deram origem a mensagem e, sempre que possível, apresenta sugestões e/ou comentários de ações que podem ser tomadas para eliminar o determinado problema. Com estas funções, o SAFO pretende ser um utilitário útil na complexa tarefa de gerenciamento de rede servindo tanto a operadores experientes como aos inexperientes, auxiliando e agilizando na execução de suas tarefas diárias de manter a rede operacional e num nível de performance satisfatório. / SAFO (Integrated System of Tools for Network Operation) is an open and integrated system built up to aid in network management work. The system results from a study of many existing tools and from the selection of a minimum set of tools necessary for network monitoring and handling. The selected tools were integrated in an environment where the user interacts with the system through a graphic interface based on windows, to facilitate the use of available tools. The high number of parameters inferent to each tool can inhibit or reduce its use, so an on-line help system for all tools was developed. Usually the messages resulting from execution of the tools are difficult to understand or are unknown, making the results quite useless. Trying to minimize this problem, the SAFO offers a Function Assistant, that helps in this interpretation interacting with a Base of Recommendations, where the resulting message , the likely cause which originated the message and, if possible, suggestions and/or comments of actions that can be taken to eliminate the problem are shown. With these functions. the SAFO intends to become an useful tool in the complex task of managing networks providing support for both experienced and beginer users, helping and speeding up the network operator's daily task of maintaining the network operational and with good performance.

Les Interfaces Cerveau-Machine (ICM) sont des systèmes qui permettent à des patients souffrant d'un handicap moteur sévère d'utiliser leur activité cérébrale pour contrôler des effecteurs, par exemple des prothèses des membres supérieurs dans le cas d'ICM motrices. Les intentions de mouvement de l'utilisateur sont estimées en appliquant un décodeur sur des caractéristiques extraites de son activité cérébrale. Des challenges spécifiques au déploiement clinique d'ICMs motrices ont été considérés, à savoir le contrôle mono-membre ou séquentiel multi-membre asynchrone et précis. Un décodeur, le Markov Switching Linear Model (MSLM), a été développé pour limiter les activations erronées de l'ICM, empêcher des mouvements parallèles des effecteurs et décoder avec précision des mouvements complexes. Le MSLM associe des modèles linéaires à différents états possibles, e.g. le contrôle d'un membre spécifique ou une phase de mouvement particulière. Le MSLM réalise une détection d'état dynamique, et les probabilités des états sont utilisées pour pondérer les modèles linéaires.La performance du décodeur MSLM a été évaluée pour la reconstruction asynchrone de trajectoires de poignet et de doigts à partir de signaux electrocorticographiques. Il a permis de limiter les activations erronées du système et d'améliorer la précision du décodage du signal cérébral. / Brain-Computer Interfaces (BCI) are systems that allow severely motor-impaired patients to use their brain activity to control external devices, for example upper-limb prostheses in the case of motor BCIs. The user's intentions are estimated by applying a decoder on neural features extracted from the user's brain activity. Signal processing challenges specific to the clinical deployment of motor BCI systems are addressed in the present doctoral thesis, namely asynchronous mono-limb or sequential multi-limb decoding and accurate decoding during active control states. A switching decoder, namely a Markov Switching Linear Model (MSLM), has been developed to limit spurious system activations, to prevent parallel limb movements and to accurately decode complex movements.The MSLM associates linear models with different possible control states, e.g. activation of a specific limb, specific movement phases. Dynamic state detection is performed by the MSLM, and the probability of each state is used to weight the linear models. The performance of the MSLM decoder was assessed for asynchronous wrist and multi-finger trajectory reconstruction from electrocorticographic signals. It was found to outperform previously reported decoders for the limitation of spurious activations during no-control periods and permitted to improve decoding accuracy during active periods.

Les maladies rares sont celles qui touchent un nombre restreint de personnes. Par conséquent, des problèmes spécifiques sont dus par cette rareté.Pour cette raison nous avons systématiquement recherché dans la littérature les publications concernant les caractéristiques des différentes méthodes mathématiques qui ont été utilisées pour l'étude des maladies rares. L'objectif est d'identifier des approches novatrices pour la recherche qui ont été, ou peuvent être, utilisées afin de surmonter les difficultés méthodologiques inhérentes à l'étude des maladies rares.Les méthodes bayésiennes sont recommandées par plusieurs auteurs et dans le cas de ces méthodes il faut introduire une loi informative a priori sur l'effet inconnu du traitement.La détermination de la loi a priori dans le modèle bayésien est difficile. Nous avons travaillé sur les méthodes qui permettent de déterminer de la loi a priori en incluant la possibilité de considérer des informations provenant des études historiques et/ou des données provenant d'autres études "voisines".D'une part, on décrit un modèle bayésien qui a pour but de vérifier l'hypothèse de non-infériorité de l'essai qui repose sur l'hypothèse que le méthotrexate est plus efficace que le corticostéroïde seul.D'autre part, notre travail de thèse se repose sur la méthode epsilon- contamination, qui se base sur le principe de contaminer une loi a priori pas entièrement satisfaisante par une série de lois provenant des informations d'autres études ayant même pathologie de maladie, même traitement ou même population.Enfin, toutes les informations a priori peuvent être résumées par la distribution a priori déterminer à partir des opinions d'experts, leur avis sont recueillis lors d'une réunion où ils ont répondu à un questionnaire qui montre leurs a priori sur les paramètres du modèle bayésien. / In recent years, scientists have difficulties to study rare diseases by conventional methods, because the sample size needed in such studies to meet a conventional frequentist power is not adapted to the number of available patients. After systemically searching in literature and characterizing different methods used in the contest of rare diseases, we remarked that most of the proposed methods are deterministic and are globally unsatisfactory because it is difficult to correct the insufficient statistical power.More attention has been placed on Bayesian models which through a prior distribution combined with a current study enable to draw decisionsfrom a posterior distribution. Determination of the prior distribution in a Bayesian model is challenging, we will describe the process of determining the prior including the possibility of considering information from some historical controlled trials and/or data coming from other studies sufficiently close to the subject of interest.First, we describe a Bayesian model that aims to test the hypothesis of the non-inferiority trial based on the hypothesis that methotrexate is more effective than corticosteroids alone.On the other hand, our work rests on the use of the epsilon-contamination method, which is based on contaminating an a priori not entirely satisfactory by a series of distributions drawn from information on other studies sharing close conditions,treatments or even populations. Contamination is a way to include the proximity of information provided bythese studies.

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.

SAFO (Sistema Agregador de Ferramentas de Operação de Rede) é um ambiente aberto e integrado que visa auxiliar na tarefa de gerenciamento de redes. O sistema e o resultado de um estudo de vários utilitários já existentes e a seleção de um conjunto mínimo necessário para a realização de monitoramento e manipulação dos componentes da rede. Os utilitários selecionadas foram integradas num típico ambiente, onde o usuário interage com o sistema através de uma interface gráfica baseada em janelas, facilitando o uso dos utilitários disponíveis. O grande número de parâmetros inerentes a cada utilitário podem inibir ou reduzir seu uso, por isso foi implementado um sistema de help on-line para todos os utilitários com o objetivo de auxiliar na sua utilização. Muitas vezes, as mensagens decorrentes da execução dos utilitários são de difícil interpretação ou são desconhecidas, o que torna o seu resultado praticamente inútil. Para tentar minimizar este problema, o SAFO oferece uma Função Assistente, que auxilia nesta interpretação interagindo com um Banco de Recomendações, onde e apresentada a mensagem resultante da execução do utilitário, as prováveis causas que deram origem a mensagem e, sempre que possível, apresenta sugestões e/ou comentários de ações que podem ser tomadas para eliminar o determinado problema. Com estas funções, o SAFO pretende ser um utilitário útil na complexa tarefa de gerenciamento de rede servindo tanto a operadores experientes como aos inexperientes, auxiliando e agilizando na execução de suas tarefas diárias de manter a rede operacional e num nível de performance satisfatório. / SAFO (Integrated System of Tools for Network Operation) is an open and integrated system built up to aid in network management work. The system results from a study of many existing tools and from the selection of a minimum set of tools necessary for network monitoring and handling. The selected tools were integrated in an environment where the user interacts with the system through a graphic interface based on windows, to facilitate the use of available tools. The high number of parameters inferent to each tool can inhibit or reduce its use, so an on-line help system for all tools was developed. Usually the messages resulting from execution of the tools are difficult to understand or are unknown, making the results quite useless. Trying to minimize this problem, the SAFO offers a Function Assistant, that helps in this interpretation interacting with a Base of Recommendations, where the resulting message , the likely cause which originated the message and, if possible, suggestions and/or comments of actions that can be taken to eliminate the problem are shown. With these functions. the SAFO intends to become an useful tool in the complex task of managing networks providing support for both experienced and beginer users, helping and speeding up the network operator's daily task of maintaining the network operational and with good performance.

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.