Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most frequently prescribed classes of drugs worldwide. Due to their excellent effects for analgesic, anti-inflammatory and antipyretic, most elder population used frequently for osteoarthritis. Gastrointestinal symptoms and ulceration associated with NSAIDs are common. Such ulcers may cause pain, bleeding, or perforation. It leads to other medical problems. The aim of this study was to examine the utilizations of medical resources associated with inpatients with NSAID related peptic ulcer disease and compared to non-NSAID related peptic ulcer disease. The study used the database from a teaching hospital in southern Taiwan. Inpatients who were identified ICD-9 CM codes as peptic ulcer diseases from January 1st of 2008 to December 31 of 2008 were included in this study. We also examined the indications for usage of NSAIDs, the date of prescription before the index date. The results showed 17.6% of inpatients with peptic ulcer disease related to NSAIDs. Inpatients with NSAIDs related peptic ulcer disease compared with inpatients with non-NSAIDs related peptic ulcer disease had significant difference in age and comorbidity. Although rapid urease test positive rate for Helicobacter pylori was higher in group of non-NSAID related peptic ulcer disease, it seemed underestimate because of the test number of patients was low. The average total direct medical cost of inpatients with NSAID related peptic ulcer was NT$ 36,491 and non-NSAID related peptic ulcer was NT$ 37,266.1. There were no significant difference in medical costs of standard care , intensive care , blood products,endoscopy, endoscopic hemostasis, surgery, CT scan , ultrasound, laboratory tests,medications, doctor¡¦s service between the two groups. Diagnostic and therapeutic procedures were no statistically significant difference, including blood transfusion,CT scan, endoscopic hemostasis, surgery, symptoms presentations, and intensive care. In this study, the duration for using NSAID was within 30 days for inpatients associated with NSAID related peptic ulcer, which had a substantial excess numbers of ulcer hospitalization. Since the common disease for using NSAID is osteoarthritis,which is very popular in elderly, therefore, we suggested that the policy makers of the National Health Insurance should be aware that preventive usage of proton pump inhibitors for the elder population who need frequent use of NSAIDs might decrease NSAID related ulcer complications.

Philosophiae Doctor - PhD / Maintenance of water resources protection practice for water availability, uninterrupted water utilization, and for ecosystem integrity is critical for sustainable achievement of resource security for all. Therefore, operationalization of water resource protection strategies such as resource directed measures, especially at catchment level where water resources utilization takes place is critical. The main aim of the current study was to develop a citizen science framework for operationalization of resource directed measures at catchment level. Such a framework used a nexus approach, and its development was guided by the principles of socio-ecological model from a systems thinking perspective. This demonstrated importance of resource directed measures which are accepted as relevant policy implementation strategies towards improved and integrated water resources management practice at catchment level, where local citizens become part of such practice.

戶政實施電腦化至今已逾10年，它開啟我國政府機關資訊化的新紀元，對處理案件的迅速、工作流程的簡化，有相當助益；在提供民眾更便捷服務之時，台北市戶政同仁却未感受到工作量的減輕，尤其因資訊化造成工作量的遽增，反而覺得工作壓力更重，離職人數更多，對此現象實有研究探討的空間。 本研究採用質化研究方法，對於資訊化後對人力配置的影響，依作業方式改變、人員配置面作實務深度訪談，並以資訊化前後辦理之案件數加以比較分析，研究發現： 一、組織編制，未能隨社會變遷調整，並依等待人數及案件類別分析，致人力配置不平衡，無法配合實際需求。 二、戶政業務有其專業性，人員替代困難。 三、部份業務未回歸相關機關辦理，又增加許多非關戶籍「業外」項目。 伍、網路憑證未能有效利用。 六、資訊化不完整，人工作業仍多，前後線作業系統無法逕為連結。 七、政策推行不够周延，配套措施不足。 因此本研究建議政府在大力推動數位化之際，對各機關間戶籍資料的介面連結，加強推動自然人憑證使用，書證的減量，有其必要性；應早日通過組織法，提高基層人員職等，解決人員流動率過高問題；政府政策實施，須有完善配套措施，如此方能落實組織再造、電子化政府的政策。 / Residential Record & Administration (RR&A) business has been computerized for over 10 years now. It opens up a new era for our government office to utilize information system technology. The system simplifies the overall work procedure and increases the efficiency of processing cases. It provides quick and convenient service to the public. However, the technology does not bring any relief in terms of work load to the staff of RR&A office in Taipei. In particular, the linking of the systems of the whole nation not only increases their work load but also brings more pressure to them. As a result, more people have quit their jobs. There is indeed a need to have further discussion about this situation. This study uses a quantitative research method to study the impact of the utilization of information system technology upon the allocation of manpower. An in-depth interview has been conducted according to the change of work procedure and the allocation of staff. In addition, the study also compares the number of cases processed before and after the use of information technology. The study discovered that: 1. The organization of RR&A office is unable to adapt quickly enough to satisfy society’s needs. The staff of RR&A is not proportioned properly according to the amount and variety of pending cases. 2. The occupation of RR&A is highly specialized, which makes it difficult to find replacement workers. 3. Some of the tasks are unrelated to the RR&A, which increase the workload of the staff. Those additional services should be assigned to their appropriate offices. 4. Online verification of identification can not be efficiently used. 5. Counter clerks and supporting staff as well as different government departments cannot communicate well with each other because the system is not comprehensive enough and a large number of work needs to be done manually. 6. Government policies are not implemented well and lack supporting resources. Therefore, this study suggests that when the government implements the digitalization on a widespread scale, it is necessary to establish system interface capability among government institutes, promote the uses of Certficate Authority of MOL（MOICA） and the reduction of certification. The constitutive law should be quickly passed to elevate the level of basic workers and decrease the amount of worker resignations. Government policies should have complete supporting resources. By doing so, the policy of restructuring the current organization to achieve a true E-government can be fully implemented.

O ser humano, já nas primeiras civilizações, tem como objetivo principal na vida prosperar e possuir uma quantidade cada vez maior de riqueza e de bens. A cultura do acúmulo de riqueza e de um consumo cada vez maior de bens e serviços faz parte então dos costumes de qualquer sociedade e economia no mundo. O crescimento econômico é, desta forma, objetivo para qualquer economia ao redor do mundo e logicamente do Brasil. Atualmente conceituado com um aumento da produção, este crescimento econômico gera uma série de impactos negativos (degradação) sobre os recursos naturais e ambientais. No longo prazo, estes impactos negativos podem estar levando a uma deterioração irreversível das reservas destes recursos, prejudicando desta forma o desempenho e a prosperidade das economias. O estudo do nível de degradação dos recursos naturais e ambientais e sua relação com o nível de crescimento econômico de uma nação é, desta forma, de grande importância pelos aspectos apresentados. O objetivo do nosso trabalho é, desta forma, exatamente este, estudar a relação entre o crescimento econômico (conceituado como um aumento do nível de renda) e o nível de degradação dos recursos naturais e ambientais, às luzes do modelo EKC (Environmental Kuznest Curve), aplicado ao Brasil. Como a degradação dos recursos naturais e ambientais é multidimensional, necessitando assim uma série de indicadores, e devido a disponibilidade de dados, foram utilizados dois tipos de indicadores: de qualidade de água e de consumo de energia. / Since the beginning of the human society, men have a main objective in life, getting wealthier and have as many goods as possible. The culture of wealthy accumulation and the consuming of a bigger quantity of goods and services is part of the characteristics of any society and economy around the world. This way, economical growth is an essential requirement for any economy, including Brazil. Defined as an improvement of the production, this economical growth also generates some other negative impacts on environmental and natural resources. In the long-run those impacts can be leading to an irreversible situation, bringing up some serious influences on the economical balance and prosperity. For those reasons, the study of the relationship between the economical growth and the degradation of the natural and environmental resources is important for a society. Thinking on it, we have developed a study that analyzes the relationship between economical growth (defined as an increase of the real GDP) and the degradation of natural and environmental resources, applying the concept of the EKC (Environmental Kuznets Curve) model in Brazil. Unfortunately, it’s needed as many indicators of pressure as possible (once that the quality of natural and environmental resources is multidimensional), but, due to that lack of data and to facilitate our study it has been applied the study to two indicators: water quality and energy consume.

O ser humano, já nas primeiras civilizações, tem como objetivo principal na vida prosperar e possuir uma quantidade cada vez maior de riqueza e de bens. A cultura do acúmulo de riqueza e de um consumo cada vez maior de bens e serviços faz parte então dos costumes de qualquer sociedade e economia no mundo. O crescimento econômico é, desta forma, objetivo para qualquer economia ao redor do mundo e logicamente do Brasil. Atualmente conceituado com um aumento da produção, este crescimento econômico gera uma série de impactos negativos (degradação) sobre os recursos naturais e ambientais. No longo prazo, estes impactos negativos podem estar levando a uma deterioração irreversível das reservas destes recursos, prejudicando desta forma o desempenho e a prosperidade das economias. O estudo do nível de degradação dos recursos naturais e ambientais e sua relação com o nível de crescimento econômico de uma nação é, desta forma, de grande importância pelos aspectos apresentados. O objetivo do nosso trabalho é, desta forma, exatamente este, estudar a relação entre o crescimento econômico (conceituado como um aumento do nível de renda) e o nível de degradação dos recursos naturais e ambientais, às luzes do modelo EKC (Environmental Kuznest Curve), aplicado ao Brasil. Como a degradação dos recursos naturais e ambientais é multidimensional, necessitando assim uma série de indicadores, e devido a disponibilidade de dados, foram utilizados dois tipos de indicadores: de qualidade de água e de consumo de energia. / Since the beginning of the human society, men have a main objective in life, getting wealthier and have as many goods as possible. The culture of wealthy accumulation and the consuming of a bigger quantity of goods and services is part of the characteristics of any society and economy around the world. This way, economical growth is an essential requirement for any economy, including Brazil. Defined as an improvement of the production, this economical growth also generates some other negative impacts on environmental and natural resources. In the long-run those impacts can be leading to an irreversible situation, bringing up some serious influences on the economical balance and prosperity. For those reasons, the study of the relationship between the economical growth and the degradation of the natural and environmental resources is important for a society. Thinking on it, we have developed a study that analyzes the relationship between economical growth (defined as an increase of the real GDP) and the degradation of natural and environmental resources, applying the concept of the EKC (Environmental Kuznets Curve) model in Brazil. Unfortunately, it’s needed as many indicators of pressure as possible (once that the quality of natural and environmental resources is multidimensional), but, due to that lack of data and to facilitate our study it has been applied the study to two indicators: water quality and energy consume.

Introduction et objectifs : La survenue d'une lésion médullaire (LM) causant une tétraplégie est un évènement tragique entraînant des conséquences dévastatrices sur la vie des individus et des coûts faramineux pour notre système de santé. Les individus qui subissent une LM traumatique avec tétraplégie nécessitent en général plusieurs semaines d’hospitalisation en centre de soins aigus où ils seront particulièrement à risque de complications médicales. Alors que des facteurs reliés au traumatisme initial ou au patient sont reconnus pour déterminer leur évolution clinique, l’impact de la gestion péri-opératoire suivant une LM parmi ces facteurs est encore imprécis. Ainsi, l’objectif principal de ce travail est d’identifier les facteurs influençant le déroulement de la phase d’hospitalisation aigue, en terme d’évolution clinique et d’utilisation de ressources hospitalières, suivant une tétraplégie aigue. Ensuite, afin de déterminer leur pertinence clinique à long terme, le second objectif de ce projet consiste à déterminer si ceux-ci ont également un impact sur la récupération fonctionnelle six mois post lésion. Méthodologie et résultats : Une étude rétrospective basée sur une banque de données prospective collectée dans un centre de traumatologie tertiaire, ainsi qu’une étude prospective prédictive ont été complétées. En plus de différents facteurs sociodémographiques et reliés au traumatisme initial (non-modifiables), une admission précoce en centre de soins spécialisés et la diminution de la survenue de complications représente des facteurs importants modifiables qui améliorent l’évolution clinique et l’utilisation de ressources en phase d’hospitalisation aigue. Une gestion chirurgicale et péri-opératoire spécialisée dans un centre pour LM influence significativement le cours de l’hospitalisation aigue en améliorant différents paramètres cliniques, de même qu’en diminuant les coûts et la durée de séjour en soins aigus chez les patients tétraplégiques. La survenue de complications médicales et l’augmentation du délai de séjour en soins aigus sont des facteurs prédictifs de récupération fonctionnelle sous-optimale six mois post-lésion. Conclusions: Le déroulement de l’hospitalisation aigue peut influencer l’évolution clinique des patients tétraplégiques et l’utilisation des ressources de notre système de santé. Mais également, le déroulement de l’hospitalisation peut avoir un impact significatif sur la récupération fonctionnelle plus de six mois post lésion. Une gestion péri-opératoire et chirurgicale précoce en centres de soins spécialisés en LM est fortement suggérée suivant une tétraplégie traumatique aigue, afin d’optimiser l’évolution clinique et le transfert des patients en réadaptation fonctionnelle intensive pour ainsi optimiser leur récupération fonctionnelle. Ceci pourrait également significativement diminuer la charge économique sur notre système de santé. Retombées : En soulevant l’importance d’une gestion optimale en soins aigus, cette étude permet d’appuyer les recommandations actuelles, de faible niveau, suggérant le transfert rapide de patients avec LM en centre spécialisés. Une gestion hospitalière aigue centrée vers la prévention des complications médicales et la récupération neuro-fonctionnelle doit être mise en place le plus tôt possible suivant une LM et particulièrement suivant une tétraplégie. Ce travail permettra ainsi de justifier l’élaboration de projets subséquents qui permettront d’élaborer des protocoles de gestion clinique et administratif plus précis, pour mieux encadrer et définir l’importance des centres de soins aigus spécialisés, et pour favoriser le transfert de connaissances en centres non spécialisés. / Introduction and objectives: The occurrence of a spinal cord injury (SCI) causing tetraplegia is a tragic event leading to devastating consequences on the life of individuals and huge costs to our healthcare system. Individuals who experience a traumatic SCI (TSCI) with tetraplegia require several weeks of hospitalisation in an acute care center where they are at risk of various medical complications. While factors related to the initial trauma or to the patient’s baseline characteristics are recognized to determine their clinical outcome, the impact of the perioperative management following a TSCI is still unclear. Thus, the main objective of this study is to identify factors influencing the course of acute care hospitalization in terms of clinical outcome and use of hospital resources following acute tetraplegia. Then, in order to determine clinical relevance of these factors in longer-term outcome of patients, the second objective of this project is to determine if these factors also have an impact on the functional recovery six months post injury. Methods and results: A retrospective cohort study in a single level-1 trauma center specialized in SCI care, and a predictive prospective study were completed. Early admission to a specialized SCI center and a decreased incidence of medical complications during acute care hospitalization were found to significantly improve clinical outcomes and decrease resource utilization during acute care. Higher occurrence of medical complications and longer acute care length of stay were significant predictors of lower functional recovery (as measured by the Spinal Cord Independence Measure six-months post injury). Conclusions: Optimization of acute care hospitalization in a specialized center may improve clinical outcomes and decrease hospital resource utilization following acute tetraplegia and thereby have a positive impact on the 6-month functional recovery. Early admission and complete perioperative management in a specialized SCI center is thus recommended following tetraplegia. This could also reduce the economic burden on our healthcare system. Clinical applications and future directions: By highlighting the importance of high-quality care following acute SCI, this study supports current recommendations suggesting prompt transfer to a specialized acute care center following tetraplegia. Acute care management focussing on the early prevention of medical complications and optimization of recovery should be provided as early as possible following tetraplegia. Future projects working towards development of precise clinical and administrative protocols for acute SCI care will help to better regulate and define the importance of specialized centers, and to promote knowledge transfer.