Gender Differences in Pain in Cancer Patients (성별에 따른 암환자의 통증 차이)
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- Journal of Hospice and Palliative Care
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- v.4 no.1
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- pp.14-25
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- 2001
Purpose : To determine whether there exist gender differences in pain in Korean cancer patients and whether the depression and performance that are often expressed differently between men and women with cancer interact with pain. Method : The results of survey were collected from 140 in- and out-patients (78 male and 62 female) who had cancer treatment at one of the university hospital in Seoul for four months from February of 1999. The severity and interference of pain were examined with the self-reported survey based on Korean version of Brief Pain Inventory (BPI-K). Demographic and clinical information for all patient were compiled by reviewing their medical records, and the level of depression was examined with the Korean version of Beck Depression Inventory (BDI-K). Usual statistical methods, e.g., frequences, means and SDs were used to characterize the sample. The chi-square tests for categorical data and t-test for numerical data were used for group comparison. And the correlation between variables were performed using Pearson correlation coefficient. Resuts : 1) The mean scores of the worst pain for last 24-hours measured with the pain severity of BPI-K were 5.77 in male and 6.45 in female. The pain interference of BPI-K in men was in the order of mood (5.49), enjoy (5.36), and work (5.00), and in women were work (7.48), enjoy (7.16), and mood (6.53). 2) In pain severity, significant difference was found between men and women in the average pain for last 24-hours (t=-2.130, P=.035). In pain interference, significant difference was found between men and women in activity (t=-2.450, P=.015), mood (t=-2,321, P=.022), walk (t=-2.762, P=.007), work (t=-4.946, P=.000), relate (t=-2.595, P=.010), sleep (t=-2.071, P=.040), enjoy (t=-3.198, P=.001). 3) It was found that the items of pain and depression are significantly correlated in men but not in women. Men also exhibited higher correlation in the items of pain and performance status than women. Conclusions : Women report significantly greater average pain for last 24-hours and for all items of pain interference than men. Pain and depression are significantly correlated in men. The results of this study suggest that gender differences in pain should be considered for planning effective pain management program.
The rule of the Warsaw Convention of 1929 are well known and still being all over the world. The Warsaw Convention is undoubtedly the most widely accepted private international air law treaty with some 140 countries. In the international legal system for air transportation, the Warsaw Convention has played a major role for more than half century, and has been revised many times in consideration of the rapid developments of air high technology, changes of social and economic circumstances, need for the protection of passengers. Some amendments became effective, but others are still not effective. As a result, the whole international legal system for air transportation is at past so complicated and tangled. However, the 'Warsaw system' consists of the Warsaw Convention of 1929 the Guadalajara Convention of 1961, a supplementary convention, and the following six protocols: (1) the Hague Protocol of 1955, (2) the Guatemala Protocol of 1971, (3) the Montreal Additional Protocols, No.1, (4) the Montreal Additional Protocol No.2, (5) the Montreal Additional Protocol No.3, and (6) the Montreal Additional Protocol No.4. of 1975. As a fundamental principle of the air carrier's liability in the international convention and protocols, for instance in the Warsaw Convention and the Hague Protocol, the principle of limited liability and a presumed fault system has been adopted. Subsequently, the Montreal Inter-carrier Agreement of 1966, the Guatemala City Protocol, the Montreal Additional Protocol No.3, and the Montreal Additional Protocol No. 4 of 1975 maintained the limited liability, but substituted the presumed liability system by an absolute liability, that is, strict liability system. The Warsaw System, which sets relatively low compensation limits for victims of aircraft accidents and regulates the limited liability for death and injury of air passengers, had become increasingly outdated. Japanese Airlines and Inter-carrier Agreement of International Air Transport Association in 1995 has been adopted the unlimited liability of air carrier in international flight. The IATA Inter-Carrier Agreement, in which airlines in international air transportation agree to waive the limit of damages, was long and hard in coming, but it was remarkable achievement given the political and economic realities of the world. IATA deserves enormous credit for bringing it about. The Warsaw System is controversial and questionable. In order to find rational solution to disputes between nations which adopted differing liability systems in international air transportation, we need to reform the liability of air carriers the 'Warsaw system' and fundamentally, to unify the liability system among the nations. The International Civil Aviation Organization(ICAO) will therefore reinforce its efforts to further promote a legal environment that adequately reflects the public interest and the needs of the parties involved. The ICAO Study Group met in April, 1998, together with the Drafting Committee. The time between the "Special Group on the Modernization and Consolidation of the 'Warsaw system'(SGMW)" and the Diplomatic Conference must be actively utilized to arrange for profound studies of the outstanding issues and for wide international consultations with a view to narrowing the scope of differences and preparing for a global international consensus. From 11 to 28 May 1999 the ICAO Headquarters at Montreal hosted a Diplomatic Conference convened to consider, with a view to adoption, a draft Convention intended to modernize and to integrate replace the instruments of the Warsaw system. The Council of ICAO convened this Conference under the Procedure for the Adoption of International Conventions. Some 525 participants from 121 Contracting States of ICAO attended, one non-contracting State, 11 observer delegations from international organizations, a total of 544 registered participants took part in the historic three-week conference which began on 10 May. The Conference was a success since it adopted a new Convention for the Unification of Certain Rules for International Carriage by Air. The 1999 Montreal Convention, created and signed by representatives of 52 countries at an international conference convened by ICAO at Montreal on May 28, 1999, came into effect on November 4, 2003. Representatives of 30 countries have now formally ratified the Convention under their respective national procedures and ratification of the United States, which was the 30th country to ratify, took place on September 5, 2003. Under Article 53.6 of the Montreal Convention, it enters into force on the 60th day following the deposit of the 30th instrument of ratification or acceptation. The United States' ratification was deposited with ICAO on September 5, 2003. The ICAO have succeeded in modernizing and consolidating a 70-year old system of international instruments of private international law into one legal instrument that will provide, for years to come, an adequate level of compensation for those involved in international aircraft accidents. An international diplomatic conference on air law by ICAO of 1999 succeeded in adopting a new regime for air carrier liability, replacing the Warsaw Convention and five other related legal instruments with a single convention that provided for unlimited liability in relation to passengers. Victims of international air accidents and their families will be better protected and compensated under the new Montreal Convention, which modernizes and consolidates a seventy-five year old system of international instruments of private international law into one legal instrument. A major feature of the new legal instrument is the concept of unlimited liability. Whereas the Warsaw Convention set a limit of 125,000 Gold Francs (approximately US$ 8,300) in case of death or injury to passengers, the Montreal Convention introduces a two-tier system. The first tier includes strict liability up to l00,000 Special Drawing Rights (SDR: approximately US$ 135,000), irrespective of a carrier's fault. The second tier is based on presumption of fault of a carrier and has no limit of liability. The 1999 Montreal Convention also includes the following main elements; 1. In cases of aircraft accidents, air carriers are called upon to provide advance payments, without delay, to assist entitled persons in meeting immediate economic needs; the amount of this initial payment will be subject to national law and will be deductable from the final settlement; 2. Air carriers must submit proof of insurance, thereby ensuring the availability of financial resources in cases of automatic payments or litigation; 3. The legal action for damages resulting from the death or injury of a passenger may be filed in the country where, at the time of the accident, the passenger had his or her principal and permanent residence, subject to certain conditions. The new Montreal Convention of 1999 included the 5th jurisdiction - the place of residence of the claimant. The acceptance of the 5th jurisdiction is a diplomatic victory for the US and it can be realistically expected that claimants' lawyers will use every opportunity to file the claim in the US jurisdiction - it brings advantages in the liberal system of discovery, much wider scope of compensable non-economic damages than anywhere else in the world and the jury system prone to very generous awards. 4. The facilitation in the recovery of damages without the need for lengthy litigation, and simplification and modernization of documentation related to passengers. In developing this new Montreal Convention, we were able to reach a delicate balance between the needs and interests of all partners in international civil aviation, States, the travelling public, air carriers and the transport industry. Unlike the Warsaw Convention, the threshold of l00,000 SDR specified by the Montreal Convention, as well as remaining liability limits in relation to air passengers and delay, are subject to periodic review and may be revised once every five years. The primary aim of unification of private law as well as the new Montreal Convention is not only to remove or to minimize the conflict of laws but also to avoid conflict of jurisdictions. In order to find a rational solution to disputes between nations which have adopted differing liability systems in international air transport, we need fundamentally to reform their countries's domestic air law based on the new Montreal Convention. It is a desirable and necessary for us to ratify rapidly the new Montreal Convention by the contracting states of lCAO including the Republic of Korea. According to the Korean and Japanese ideas, airlines should not only pay compensation to passengers immediately after the accident, but also the so-called 'condolence' money to the next of kin. Condolence money is a gift to help a dead person's spirit in the hereafter : it is given on account of the grief and sorrow suffered by the next of kin, and it has risen considerably over the years. The total amount of the Korean and Japanese claims in the case of death is calculated on the basis of the loss of earned income, funeral expenses and material demage (baggage etc.), plus condolence money. The economic and social change will be occurred continuously after conclusion of the new Montreal Convention. In addition, the real value of life and human right will be enhanced substantially. The amount of compensation for damage caused by aircraft accident has increased in dollar amount as well as in volume. All air carrier's liability should extend to loss of expectation of leisure activities, as well as to damage to property, and mental and physical injuries. When victims are not satisfied with the amount of the compensation for damage caused by aircraft accident for which an airline corporation is liable under the current liability system. I also would like to propose my opinion that it is reasonable and necessary for us to interpret broadly the meaning of the bodily injury on Article 17 of the new Montreal Convention so as to be included the mental injury and condolence. Furthermore, Korea and Japan has not existed the Air Transport Act regulated the civil liability of air carrier such as Air Transport Act (Luftverkehrsgestz) in Germany. It is necessary for us to enact "the Korean Air Transport Contract Act (provisional title)" in order to regulate the civil liability of air carrier including the protection of the victims and injured persons caused by aircraft accident.
The interplay between hedonic and utilitarian attributes has assumed special significance in recent years; it has been proposed that consumption offerings should be viewed as experiences that stimulate both cognitions and feelings rather than as mere products or services. This research builds on previous work on hedonic versus utilitarian benefits, regulatory focus theory, customer satisfaction to address two question: (1) Is the shopping goal at the point of purchase different from the shopping value? and (2) Is the customer loyalty after the use different from the shopping value and shopping goal? We surveyed 345 peoples those who have bought the electronic-goods within 6 months. This research dealt with the shopping value which is consisted of 2 types, hedonic and utilitarian. Those who pursue the hedonic shopping value may prefer the pleasure of purchasing experience to the product itself. They tend to prefer atmosphere, arousal of the shopping experience. Consistent with previous research, we use the term "hedonic" to refer to their aesthetic, experiential and enjoyment-related value. On the contrary, Those who pursue the utilitarian shopping value may prefer the reasonable buying. It may be more functional. Consistent with previous research, we use the term "utilitarian" to refer to the functional, instrumental, and practical value of consumption offerings. Holbrook(1999) notes that consumer value is an experience that results from the consumption of such benefits. In the context of cell phones for example, the phone's battery life and sound volume are utilitarian benefits, whereas aesthetic appeal from its shape and color are hedonic benefits. Likewise, in the case of a car, fuel economics and safety are utilitarian benefits whereas the sunroof and the luxurious interior are hedonic benefits. The shopping goals are consisted of the promotion focus goal and the prevention focus goal, based on the self-regulatory focus theory. The promotion focus is characterized into focusing ideal self because they are oriented to wishes and vision. The promotion focused individuals are tend to be more risk taking. They are more sensitive to hope and achievement. On the contrary, the prevention focused individuals are characterized into focusing the responsibilities because they are oriented to safety. The prevention focused individuals are tend to be more risk avoiding. We wanted to test the relation among the shopping value, shopping goal and customer loyalty. Customers show the positive or negative feelings comparing with the expectation level which customers have at the point of the purchase. If the result were bigger than the expectation, customers may feel positive feeling such as delight or satisfaction and they would want to share their feelings with other people. And they want to buy those products again in the future time. There is converging evidence that the types of goals consumers expect to be fulfilled by the utilitarian dimension of a product are different from those they seek from the hedonic dimension (Chernev 2004). Specifically, whereas consumers expect the fulfillment of product prevention goals on the utilitarian dimension, they expect the fulfillment of promotion goals on the hedonic dimension (Chernev 2004; Chitturi, Raghunathan, and Majahan 2007; Higgins 1997, 2001) According to the regulatory focus theory, prevention goals are those that ought to be met. Fulfillment of prevention goals in the context of product consumption eliminates or significantly reduces the probability of a painful experience, thus making consumers experience emotions that result from fulfillment of prevention goals such as confidence and securities. On the contrary, fulfillment of promotion goals are those that a person aspires to meet, such as "looking cool" or "being sophisticated." Fulfillment of promotion goals in the context of product consumption significantly increases the probability of a pleasurable experience, thus enabling consumers to experience emotions that result from the fulfillment of promotion goals. The proposed conceptual framework captures that the relationships among hedonic versus utilitarian shopping values and promotion versus prevention shopping goals respectively. An analysis of the consequence of the fulfillment and frustration of utilitarian and hedonic value is theoretically worthwhile. It is also substantively relevant because it helps predict post-consumption behavior such as the promotion versus prevention shopping goals orientation. Because our primary goal is to understand how the post consumption feelings influence the variable customer loyalty: word of mouth (Jacoby and Chestnut 1978). This research result is that the utilitarian shopping value gives the positive influence to both of the promotion and prevention goal. However the influence to the prevention goal is stronger. On the contrary, hedonic shopping value gives influence to the promotion focus goal only. Additionally, both of the promotion and prevention goal show the positive relation with customer loyalty. However, the positive relation with promotion goal and customer loyalty is much stronger. The promotion focus goal gives the influence to the customer loyalty. On the contrary, the prevention focus goal relates at the low level of relation with customer loyalty than that of the promotion goal. It could be explained that it is apt to get framed the compliment of people into 'gain-non gain' situation. As the result, for those who have the promotion focus are motivated to deliver their own feeling to other people eagerly. Conversely the prevention focused individual are more sensitive to the 'loss-non loss' situation. The research result is consistent with pre-existent researches. There is a conceptual parallel between necessities-needs-utilitarian benefits and luxuries-wants-hedonic benefits (Chernev 2004; Chitturi, Raghunathan and Majaha 2007; Higginns 1997; Kivetz and Simonson 2002b). In addition, Maslow's hierarchy of needs and the precedence principle contends luxuries-wants-hedonic benefits higher than necessities-needs-utilitarian benefits. Chitturi, Raghunathan and Majaha (2007) show that consumers are focused more on the utilitarian benefits than on the hedonic benefits of a product until their minimum expectation of fulfilling prevention goals are met. Furthermore, a utilitarian benefit is a promise of a certain level of functionality by the manufacturer or the retailer. When the promise is not fulfilled, customers blame the retailer and/or the manufacturer. When negative feelings are attributable to an entity, customers feel angry. However in the case of hedonic benefit, the customer, not the manufacturer, determines at the time of purchase whether the product is stylish and attractive. Under such circumstances, customers are more likely to blame themselves than the manufacturer if their friends do not find the product stylish and attractive. Therefore, not meeting minimum utilitarian expectations of functionality generates a much more intense negative feelings, such as anger than a less intense feeling such as disappointment or dissatisfactions. The additional multi group analysis of this research shows the same result. Those who are unsatisfactory customers who have the prevention focused goal shows higher relation with WOM, comparing with satisfactory customers. The research findings in this article could have significant implication for the personal selling fields to increase the effectiveness and the efficiency of the sales such that they can develop the sales presentation strategy for the customers. For those who are the hedonic customers may be apt to show more interest to the promotion goal. Therefore it may work to strengthen the design, style or new technology of the products to the hedonic customers. On the contrary for the utilitarian customers, it may work to strengthen the price competitiveness. On the basis of the result from our studies, we demonstrated a correspondence among hedonic versus utilitarian and promotion versus prevention goal, WOM. Similarly, we also found evidence of the moderator effects of satisfaction after use, between the prevention goal and WOM. Even though the prevention goal has the low level of relation to WOM, those who are not satisfied show higher relation to WOM. The relation between the prevention goal and WOM is significantly different according to the satisfaction versus unsatisfaction. In addition, improving the promotion emotions of cheerfulness and excitement and the prevention emotion of confidence and security will further improve customer loyalty. A related potential further research could be to examine whether hedonic versus utilitarian, promotion versus prevention goals improve customer loyalty for services as well. Under the budget and time constraints, designers and managers are often compelling to choose among various attributes. If there is no budget or time constraints, perhaps the best solution is to maximize both hedonic and utilitarian dimension of benefits. However, they have to make trad-off process between various attributes. For the designers and managers have to keep in mind that without hedonic benefit satisfaction of the product it may hard to lead the customers to the customer loyalty.
The basic purpose of this study is to investigate perceived quality and service personal value affecting the result of long-term relationship between service buyers and suppliers. This research presented a constructive model(perceived quality affecting the service personal value and the moderate effect of NFC) in the on off line and then propose the research model base on prior researches and studies about relationships among components of service. Data were gathered from respondents who visit at the education service market. For this study, Data were analyzed by AMOS 7.0. We integrate the literature on services marketing with researches on personal values and perceived quality. The SERPVAL scale presented here allows for the creation of a common ground for assessing service personal values, giving a clear understanding of the key value dimensions behind service choice and usage. It will lead to a focus of future research in services marketing, extending knowledge in the field and stimulating further empirical research on service personal values. At the managerial level, as a tool the SERPVAL scale should allow practitioners to evaluate and improve the value of a service, and consequently, to define strategies and actions to address services for customers based on their fundamental personal values. Through qualitative and empirical research, we find that the service quality construct conforms to the structure of a second-order factor model that ties service quality perceptions to distinct and actionable dimensions: outcome, interaction, and environmental quality. In turn, each has two subdimensions that define the basis of service quality perceptions. The authors further suggest that for each of these subdimensions to contribute to improved service quality perceptions, the quality received by consumers must be perceived to be reliable, responsive, and empathetic. Although the service personal value may be found in researches that explore individual values and their consequences for consumer behavior, there is no established operationalization of a SERPVAL scale. The inexistence of an established scale, duly adapted in order to understand and analyze personal values behind services usage, exposes the need of a measurement scale with such a purpose. This need has to be rooted, however, in a conceptualization of the construct being scaled. Service personal values can be defined as a customer's overall assessment of the use of a service based on the perception of what is achieved in terms of his own personal values. As consumer behaviors serve to show an individual's values, the use of a service can also be a way to fulfill and demonstrate consumers'personal values. In this sense, a service can provide more to the customer than its concrete and abstract attributes at both the attribute and the quality levels, and more than its functional consequences at the value level. Both values and services literatures agree, that personal value is the highest-level concept, followed by instrumental values, attitudes and finally by product attributes. Purchasing behaviors are agreed to be the end result of these concepts' interaction, with personal values taking a major role in the final decision process. From both consumers' and practitioners' perspectives, values are extremely relevant, as they are desirable goals that serve as guiding principles in people's lives. While building on previous research, we propose to assess service personal values through three broad groups of individual dimensions; at the self-oriented level, we use (1) service value to peaceful life (SVPL) and, at the social-oriented level, we use (2) service value to social recognition (SVSR), and (3) service value to social integration (SVSI). Service value to peaceful life is our first dimension. This dimension emerged as a combination of values coming from the RVS scale, a scale built specifically to assess general individual values. If a service promotes a pleasurable life, brings or improves tranquility, safety and harmony, then its user recognizes the value of this service. Generally, this service can improve the user's pleasure of life, since it protects or defends the consumer from threats to life or pressures on it. While building upon both the LOV scale, a scale built specifically to assess consumer values, and the RVS scale for individual values, we develop the other two dimensions: SVSR and SVSI. The roles of social recognition and social integration to improve service personal value have been seriously neglected. Social recognition derives its outcome utility from its predictive utility. When applying this underlying belief to our second dimension, SVSR, we assume that people use a service while taking into consideration the content of what is delivered. Individuals consider whether the service aids in gaining respect from others, social recognition and status, as well as whether it allows achieving a more fulfilled and stimulating life, which might then be revealed to others. People also tend to engage in behavior that receives social recognition and to avoid behavior that leads to social disapproval, and this contributes to an individual's social integration. This leads us to the third dimension, SVSI, which is based on the fact that if the consumer perceives that a service strengthens friendships, provides the possibility of becoming more integrated in the group, or promotes better relationships at the social, professional or family levels, then the service will contribute to social integration, and naturally the individual will recognize personal value in the service. Most of the research in business values deals with individual values. However, to our knowledge, no study has dealt with assessing overall personal values as well as their dimensions in a service context. Our final results show that the scales adapted from the Schwartz list were excluded. A possible explanation is that although Schwartz builds on Rokeach work in order to explore individual values, its dimensions might be especially focused on analyzing societal values. As we are looking for individual dimensions, this might explain why the values inspired by the Schwartz list were excluded from the model. The hierarchical structure of the final scale presented in this paper also presents theoretical implications. Although we cannot claim to definitively capture the dimensions of service personal values, we believe that we come close to capturing these overall evaluations because the second-order factor extracts the underlying commonality among dimensions. In addition to obtaining respondents' evaluations of the dimensions, the second-order factor model captures the common variance among these dimensions, reflecting the respondents' overall assessment of service personal values. Towards this fact, we expect that the service personal values conceptualization and measurement scale presented here contributes to both business values literature and the service marketing field, allowing for the delineation of strategies for adding value to services. This new scale also presents managerial implications. The SERPVAL dimensions give some guidance on how to better pursue a highly service-oriented business strategy. Indeed, the SERPVAL scale can be used for benchmarking purposes, as this scale can be used to identify whether or not a firms' marketing strategies are consistent with consumers' expectations. Managerial assessment of the personal values of a service might be extremely important because it allows managers to better understand what customers want or value. Thus, this scale allows us to identify what services are really valuable to the final consumer; providing knowledge for making choices regarding which services to include. Traditional approaches have focused their attention on service attributes (as quality) and service consequences(as service value), but personal values may be an important set of variables to be considered in understanding what attracts consumers to a certain service. By using the SERPVAL scale to assess the personal values associated with a services usage, managers may better understand the reasons behind services' usage, so that they may handle them more efficiently. While testing nomological validity, our empirical findings demonstrate that the three SERPVAL dimensions are positively and significantly associated with satisfaction. Additionally, while service value to social integration is related only with loyalty, service value to peaceful life is associated with both loyalty and repurchase intent. It is also interesting and surprising that service value to social recognition appears not to be significantly linked with loyalty and repurchase intent. A possible explanation is that no mobile service provider has yet emerged in the market as a luxury provider. All of the Portuguese providers are still trying to capture market share by means of low-end pricing. This research has implications for consumers as well. As more companies seek to build relationships with their customers, consumers are easily able to examine whether these relationships provide real value or not to their own lives. The selection of a strategy for a particular service depends on its customers' personal values. Being highly customer-oriented means having a strong commitment to customers, trying to create customer value and understanding customer needs. Enhancing service distinctiveness in order to provide a peaceful life, increase social recognition and gain a better social integration are all possible strategies that companies may pursue, but the one to pursue depends on the outstanding personal values held by the service customers. Data were gathered from 284 respondents in the korean discount store and online shopping mall market. This research proposed 3 hypotheses on 6 latent variables and tested through structural equation modeling. 6 alternative measurements were compared through statistical significance test of the 6 paths of research model and the overall fitting level of structural equation model. and the result was successful. and Perceived quality more positively influences service personal value when NFC is high than when no NFC is low in the off-line market. The results of the study indicate that service quality is properly modeled as an antecedent of service personal value. We consider the research and managerial implications of the study and its limitations. In sum, by knowing the dimensions a consumer takes into account when choosing a service, a better understanding of purchasing behaviors may be realized, guiding managers toward customers expectations. By defining strategies and actions that address potential problems with the service personal values, managers might ultimately influence their firm's performance. we expect to contribute to both business values and service marketing literatures through the development of the service personal value. At a time when marketing researchers are challenged to provide research with practical implications, it is also believed that this framework may be used by managers to pursue service-oriented business strategies while taking into consideration what customers value.