We tried to observe the features of ancient medical practice by analysing the records related to medicine in the book, ${\ulcorner}$the Historical Records of the Three Kingdom${\lrcorner}$ of which content includes the features of medicine in mythology, plague, delivery of twins, drugs, medical system, shamanism, constitutional medicine, psychiatry, forensic medicine, deformity, a spa, medical phrase, health and welfare work, religion, death. physiological anatomy, Taoist medicine, acupuncture, the occult af of transformation and etc. Our initial concern was about where to draw line as of medical field and we defined medicine in more broad meaning. The book ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$ describes the world of mythology by way of medicine which is not clearly a conventional one. There appears records of birth of multiple offsprings 7 times in which cases are of triplets or more. Delivering multiple offsprings were rare phenomenon though such fertility was highly admired. This shows one aspect of ancient country having more population meant more power of the nation. Of those medical records conveyed in that book includes stories of childbirth such as giving birth to a son after praying, giving birth to Kim Yoo-shin after 20 months after mother's dream of conception, and a song longing for getting a laudable child. Plagues were prevalent throughout winter to spring season and one can observe various symptoms of plagues in the record. Of these epidemic diseases, cold type might have been more common than the heat one. Appearance of epidemic diseases frequently coincided with that of natural disasters that this suggests a linkage between plague and underlying doctrine on five elements' motion and six kinds of natural factors. There exists only a few names of diseases such as epidemic disease, wind disease, and syndrome characterized by dyspnea. Otherwise there appeared only afflictions that were not specified therefore it remains cluless to keep track of certain diseases of prevalence. Since this ${\ulcorner}$Historical Records of the Three Kingdoms'${\lrcorner}$ wasn't any sort of medical book, words and terms used were not technical kind and most were the ones used generally among lay people. Therefore any mechanisms of the diseases were hardly mentioned. Some of medicinal substances such as Calculus Bovis, Radix Ginseng, Gaboderma Luciderm, magnetitum were also in use in those days. 53 kinds of dietary supplies appears in the records and some of these might have been used as medicinal purpose. Records concerning dicipline of one's body includes activities such as hunting, archery, horseback riding etc. In Shilla dynasty there were positions such as professor of medicine, Naekongbong(內供奉), Kongbong's doctor(供奉醫師), Kongbong's diviner(供奉卜師). As an educational facility, medical school was built at the first year of King Hyoso's reign and it's curricula included various subjects as ${\ulcorner}$Shin Nong's Herbal classic${\lrcorner}$, ${\ulcorner}$Kabeul classic of acupuncture and moxbustion${\lrcorner}$, ${\ulcorner}$The Plain Questions of the Yellow Emperor's Classic of Internal Medicine${\lrcorner}$, ${\ulcorner}$Classic of Acupuncturer${\lrcorner}$, ${\ulcorner}$The Pulse Classic${\lrcorner}$, ${\ulcorner}$Classic of Channels and Acupuncture Points${\lrcorner}$ and ${\ulcorner}$Difficult Classic${\lrcorner}$. There were 2 medical professors who were in charge of education. To establish pharmacopoeia, 2 Shaji(舍知), 6 Sha(史), 2 Jongshaji(從舍知) were appointed. In Baekje dynasty, Department of Herb was maintained. Doing praying for the sake of health, doing phrenology also can be extended to medical arena. Those who survived over 100 years of age appear 3 times in the record, while 98 appears once. The earliest psychiatrist Nokjin differentiated symptoms to apply either therapies using acupuncture and drug or psychotherapy. There appears a case of rape, a case of burying alive with the dead, 8 cases of suicide that can characterize a prototype of forensic medicine. Deformity-related records include phrases as follow: 'there seems protrudent bone behind the head', 'a body which has two heads, two trunks, four arms.', 'a body equipped with two heads' In those times spa can be said to be used as a place for he리ing, convalescence, and relaxation seeing the records describing a person pretended illness and went to spa to enjoy with his friends. Priest doctors and millitary surgeons were in charge of the medical sevice in the period of the Three Kingdoms by the record written by Mookhoja(墨胡子) and Hoonkyeom(訓謙). Poor diet and regimen makes people more vulnerable to diseases. So there existed charity services for those poor people who couldn't live with one's own capacity such as single parents, orphans, the aged people no one to take care and those who are ill. The cause of affliction was frequently coined with human relation. There appeared the phenomenon of releasing prisoners and allowing people to become priests at the time of king's suffering. Besides, as a healing procedure, sutra-chanting was peformed. There appears 10 cases of death related records which varies from death by drowning, or by freezing, death from animals, death from war, death from wightloss and killing oneself at the moment of spouse's death and etc. There also exist certain records which suggest the knowledge of physiology and anatomy in those times. Since the taoist books such as ${\ulcorner}$Book of the Way and Its Power(老子道德經)${\lrcorner}$ were introduced in the period of Three Kingdoms, it can be considered that medicine was also influenced by taoism. Records of higher level of acupuncture, records which links the medicine and occult art of transformation existed. Although limited, we could figure out the medical state of ancient society.
1. Introduction: Contrast to the offline purchasing environment, online store cannot offer the sense of touch or direct visual information of its product to the consumers. So the builder of the online shopping mall should provide more concrete and detailed product information(Kim 2008), and Alba (1997) also predicted that the quality of the offered information is determined by the post-purchase consumer satisfaction. In practice, many fashion and apparel online shopping malls offer the picture information with the product on the real person model to enhance the usefulness of product information. On the other virtual product experience has been suggested to the ways of overcoming the online consumers' limited perceptual capability (Jiang & Benbasat 2005). However, the adoption and the facilitation of the virtual reality tools requires high investment and technical specialty compared to the text/picture product information offerings (Shaffer 2006). This could make the entry barrier to the online shopping to the small retailers and sometimes it could be demanding high level of consumers' perceptual efforts. So the expensive technological solution could affects negatively to the consumer decision making processes. Nevertheless, most of the previous research on the online product information provision suggests the VR be the more effective tools. 2. Research Model and Hypothesis: Presented in
, research model suggests VR effect could be moderated by the product types by the usage situations. Product types could be defined as the portable product and installed product, and the information offering type as still picture of the product, picture of the product with the real-person model and VR. 3. Methods and Results: 3.1. Experimental design and measured variables We designed the 2(product types) X 3(product information types) experimental setting and measured dependent variables such as information usefulness, attitude toward the shopping mall, overall product quality, purchase intention and the revisiting intention. In the case of information usefulness and attitude toward the shopping mall were measured by multi-item scale. As a result of reliability test, Cronbach's Alpha value of each variable shows more than 0.6. Thus, we ensured that the internal consistency of items. 3.2. Manipulation check The main concern of this study is to verify the moderate effect by the product type of usage situation.
indicates that our experimental manipulation of the moderate effect of the product type was successful. 3.3. Results As
indicates, there was a significant main effect on the only one dependent variable(attitude toward the shopping mall) by the information types. As predicted, VR has highest mean value compared to other information types. Thus, H1 was partially supported. However, main effect by the product types was not found. To evaluate H2 and H3, a two-way ANOVA was conducted. As
indicates, there exist the interaction effects on the three dependent variables(information usefulness, overall product quality and purchase intention) by the information types and the product types. As predicted, picture of the product with the real-person model has highest mean among the information types in the case of portable product. On the other hand, VR has highest mean among the information types in the case of installed product. Thus, H2 and H3 was supported. 4. Implications: The present study found the moderate effect by the product type of usage situation. Based on the findings the following managerial implications are asserted. First, it was found that information types are affect only the attitude toward the shopping mall. The meaning of this finding is that VR effects are not enough to understand the product itself. Therefore, we must consider when and how to use this VR tools. Second, it was found that there exist the interaction effects on the information usefulness, overall product quality and purchase intention. This finding suggests that consideration of usage situation helps consumer's understanding of product and promotes their purchase intention. In conclusion, not only product attributes but also product usage situations must be fully considered by the online retailers when they want to meet the needs of consumers.
Along with the development of scientific technologies, health care has been growing remarkably, and as the social life quality improves with increasing interest in health, the demand for medical service is rapidly increasing. However, medical accident and medical dispute also are rapidly increasing due to various factors such as, increasing sense of people's right, lack of understanding in the nature of medical practice, over expectation on medical technique, commercialize medical supply system, moral degeneracy and unawareness of medical jurisprudence by doctors, widespread trend of mutual distrust, and lack of systematized device for solution of medical dispute. This study analysed 30 cases of civil suit in the year between 1994 to 2004, which were selected among the medical dispute cases in dental field with the judgement collected from organizations related to dentistry and department of oral medicine, Yonsei university dental hospital. The following results were drawn from the analyses: 1. The distribution of year showed rapid increase of medical dispute after the year 2000. 2. In the types of medical dispute, suit associated with tooth extraction took 36.7% of all. 3. As for the cause of medical dispute, uncomfortable feeling and dissatisfaction with the treatment showed 36.7%, death and permanent damage showed 16.7% each. 4. Winning the suit, compulsory mediation and recommendation for settlement took 60.0% of judgement result for the plaintiff. 5. For the type of medical organization in relation to medical dispute, 60.0% was found to be the private dental clinics, and 30.0% was university dental hospitals. 6. For the level of trial, dispute that progressed above 2 or 3 trials was of 30.0%. 7. For the amount of claim for damage, the claim amounting between 50 million to 100 million won was of 36.7%, and that of more than 100 million won was 13.3%, and in case of the judgement amount, the amount ranging from 10 million to 30 million won was of 40.0%, and that of more than 100 million won was of 6.7%. 8. For the number of dentist involved in the suit, 26.7% was of 2 or more dentists. 9. For the amount of time spent until the judgement, 46.7% took 11 to 20 months, and 36.7% took 21 to 30 months. 10. For medical malpractice, 46.7% was judged to be guilty, and 70% of the cases had undergone medical judgement or verification of the case by specialists during the process of the suit. 11. In the lost cases of doctors(18 cases), 72.2% was due to violence of carefulness in practice and 16.7% was due to missing of explanation to patient. Medical disputes occurring in the field of dentistry are usually of relatively less risky cases. Hence, the importance of explanation to patient is emphasized, and since the levels of patient satisfaction are subjective, improvement of the relationship between the patient and the dentist and recovery of autonomy within the group dentist are essential in addition to the reduction of technical malpractice. Moreover, management measure against the medical dispute should be set up through complement of the current doctors and hospitals medical malpractice insurance which is being conducted irrationally, and establishment of system in which education as well as consultation for medical disputes lead by the group of dental clinicians and academic scholars are accessible.
UGC(User Generated Contents) is emerging as the center of e-business in the web 2.0 era. The trend reflects changing roles of users in production and consumption of contents on websites and helps us to understand new strategies of websites such as web portals and social network websites. Nowadays, we consume contents created by other non-professional users for both utilitarian (e.g., knowledge) and hedonic values (e.g., fun). Also, contents produced by ourselves (e.g., photo, video) are posted on websites so that our friends, family, and even the public can consume those contents. This means that non-professionals, who used to be passive audience in the past, are now creating contents and share their UGCs with others in the Web. Accessible media, tools, and applications have also reduced difficulty and complexity in the process of creating contents. Realizing that users create plenty of materials which are very interesting to other people, media companies (i.e., web portals and social networking websites) are adjusting their strategies and business models accordingly. Increased demand of UGC may lead to website visits which are the source of benefits from advertising. Therefore, they put more efforts into making their websites open platforms where UGCs can be created and shared among users without technical and methodological difficulties. Many websites have increasingly adopted new technologies such as RSS and openAPI. Some have even changed the structure of web pages so that UGC can be seen several times to more visitors. This mainstream of UGCs on websites indicates that acquiring more UGCs and supporting participating users have become important things to media companies. Although those companies need to understand why general users have shown increasing interest in creating and posting contents and what is important to them in the process of productions, few research results exist in this area to address these issues. Also, behavioral process in creating video UGCs has not been explored enough for the public to fully understand it. With a solid theoretical background (i.e., theory of implementation intentions), parts of our proposed research model mirror the process of user behaviors in creating video contents, which consist of intention to upload, intention to edit, edit, and upload. In addition, in order to explain how those behavioral intentions are developed, we investigated influences of antecedents from three motivational perspectives (i.e., intrinsic, editing software-oriented, and website's network effect-oriented). First, from the intrinsic motivation perspective, we studied the roles of self-expression, enjoyment, and social attention in forming intention to edit with preferred editing software or in forming intention to upload video contents to preferred websites. Second, we explored the roles of editing software for non-professionals to edit video contents, in terms of how it makes production process easier and how it is useful in the process. Finally, from the website characteristic-oriented perspective, we investigated the role of a website's network externality as an antecedent of users' intention to upload to preferred websites. The rationale is that posting UGCs on websites are basically social-oriented behaviors; thus, users prefer a website with the high level of network externality for contents uploading. This study adopted a longitudinal research design; we emailed recipients twice with different questionnaires. Guided by invitation email including a link to web survey page, respondents answered most of questions except edit and upload at the first survey. They were asked to provide information about UGC editing software they mainly used and preferred website to upload edited contents, and then asked to answer related questions. For example, before answering questions regarding network externality, they individually had to declare the name of the website to which they would be willing to upload. At the end of the first survey, we asked if they agreed to participate in the corresponding survey in a month. During twenty days, 333 complete responses were gathered in the first survey. One month later, we emailed those recipients to ask for participation in the second survey. 185 of the 333 recipients (about 56 percentages) answered in the second survey. Personalized questionnaires were provided for them to remind the names of editing software and website that they reported in the first survey. They answered the degree of editing with the software and the degree of uploading video contents to the website for the past one month. To all recipients of the two surveys, exchange tickets for books (about 5,000~10,000 Korean Won) were provided according to the frequency of participations. PLS analysis shows that user behaviors in creating video contents are well explained by the theory of implementation intentions. In fact, intention to upload significantly influences intention to edit in the process of accomplishing the goal behavior, upload. These relationships show the behavioral process that has been unclear in users' creating video contents for uploading and also highlight important roles of editing in the process. Regarding the intrinsic motivations, the results illustrated that users are likely to edit their own video contents in order to express their own intrinsic traits such as thoughts and feelings. Also, their intention to upload contents in preferred website is formed because they want to attract much attention from others through contents reflecting themselves. This result well corresponds to the roles of the website characteristic, namely, network externality. Based on the PLS results, the network effect of a website has significant influence on users' intention to upload to the preferred website. This indicates that users with social attention motivations are likely to upload their video UGCs to a website whose network size is big enough to realize their motivations easily. Finally, regarding editing software characteristic-oriented motivations, making exclusively-provided editing software more user-friendly (i.e., easy of use, usefulness) plays an important role in leading to users' intention to edit. Our research contributes to both academic scholars and professionals. For researchers, our results show that the theory of implementation intentions is well applied to the video UGC context and very useful to explain the relationship between implementation intentions and goal behaviors. With the theory, this study theoretically and empirically confirmed that editing is a different and important behavior from uploading behavior, and we tested the behavioral process of ordinary users in creating video UGCs, focusing on significant motivational factors in each step. In addition, parts of our research model are also rooted in the solid theoretical background such as the technology acceptance model and the theory of network externality to explain the effects of UGC-related motivations. For practitioners, our results suggest that media companies need to restructure their websites so that users' needs for social interaction through UGC (e.g., self-expression, social attention) are well met. Also, we emphasize strategic importance of the network size of websites in leading non-professionals to upload video contents to the websites. Those websites need to find a way to utilize the network effects for acquiring more UGCs. Finally, we suggest that some ways to improve editing software be considered as a way to increase edit behavior which is a very important process leading to UGC uploading.
The Royal Private Shrines or the Samyo(私廟), were dedicated to members of Choseon's royal family who could not be enshrined at the (official) Royal Ancestral Shrine, the Jongmyo(宗廟). The Samyo were constructed at the national level and were systematically managed as such. Because these private Shrines were dedicated to those who couldn't belong to the Jongmyo but were still very important, such as the ruling king's biological father or mother. The details of all royal constructions were included in the State Event Manuals, and with them, the two-dimensional layouts of the Samyo also. From the remaining "Hyunsa-gung Private Tomb Construction Layout Record(顯思宮別廟營建都監儀軌)" of 1824, which is the construction record of Gyeongwoo-gung Shrine(景祐宮) dedicated to Subin, the mother of King Sunjo(純祖), it became possible to investigate the so far unknown "The Painting of Gyeongwoo-gung Shrine", in terms of the year produced, materials used and other situational contexts. The investigation revealed that the "The Painting of Gyeongwoo-gung Shrine" is actually the "Hyunsa-gung Private Tomb Layout" produced by the Royal Construction Bureau. The bureau painted this to build Hyunsa-gung Private Shrine in a separately prepared site outside the court in 1824, according to the royal verdict to close down and move the temporary shrine inside the courtyard dedicated to Subin who had passed away in 1822. As the Construction Bureau must have also produced the Gyeongwoo-gung Shrine Layout, the painter(s) of this layout should exist among the official artists listed in the State Event Manual, but sadly, as their paintings have not survived to this day, we cannot compare their painting styles. The biggest stylistic character of the Painting of Gyeongwoo-gung Shrine is its perfect diagonal composition method and detailed and neat portrayalof the many palace buildings, just as seen in Donggwoldo(東闕圖, Painting of a panoramic view for Changdeokgung and Changgyeonggung Palaces). A well-perceiving architectural painting employs a specific point of view chosen to fit the purpose of the painting, or it can opt to the multi-viewpoint. Korean traditional architectural paintings in early ages utilized the diagonal composition method, the bird-eye viewpoint, or the multi-viewpoint. By the 18th century, detailed but also artistic architectural paintings utilizing the diagonal method are observed. In the early 19th century, the peak of such techniques is exhibited in Donggwoldo(Painting of a panoramic view for Changdeokgung and Changgyeonggung Palaces). From the perfect diagonal composition method employed and the details of the palace buildings numbering almost two hundreds, we can determine that the Painting of Gyeongwoo-gung Shrine also belongs to the same category of the highly technical architectural paintings as Donggwoldo(Painting of a panoramic view for Changdeokgung and Changgyeonggung Palaces). We can also confirm this hypothesis by comparing the painting techniques employed in these two paintings in detailthe way trees and houses are depicted, and the way ground texture is expressed, etc. The unique characteristic of the Painting of Gyeongwoo-gung Shrine is, however, that the area surrounding the central shrine building(正堂), the most important area of the shrine, is drawn using not the diagonal method but the bird-eye viewpoint with the buildings lying flat on both the left and right sides, just as seen in the "Buildings Below the Central Shrine(正堂以下諸處)" in the State Event Manual's Painting Method section. The same viewpoint method is discovered in some other concurrent paintings of common residential buildings, so it is not certain that this particular viewpoint had been a distinctive feature for shrine paintings in general. On the other hand, when the diagonalmethod pointing to the left direction is chosen, the top-left and bottom-right sections of the painting become inevitably empty. This has been the case for the Painting of Gyeongwoo-gung Shrine, but in contrast, Donggwoldo shows perfect screen composition with these empty margins filled up with different types of trees and other objects. Such difference is consistent with the different situational contexts of these two paintings: the Painting of Gyeongwoo-gung Shrine is a simple single-sheet painting, while Donggwoldo is a perfected work of painting book given an official title. Therefore, if Donggwoldo was produced to fulfill the role of depiction and documentation as well as the aesthetic purpose, contrastingly, the Painting of Gyeongwoo-gung Shrine only served the purpose of copying the circumstances of the architecture and projecting them onto the painting.
Ha, Sangjip;Lee, Junsik;Yoo, In-Jin;Park, Do-Hyung
Journal of Intelligence and Information Systems
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v.27
no.2
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pp.55-78
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2021
Tosolve complex and diverse social problems and ensure the quality of life of individuals, social robots that can interact with humans are attracting attention. In the past, robots were recognized as beings that provide labor force as they put into industrial sites on behalf of humans. However, the concept of today's robot has been extended to social robots that coexist with humans and enable social interaction with the advent of Smart technology, which is considered an important driver in most industries. Specifically, there are service robots that respond to customers, the robots that have the purpose of edutainment, and the emotionalrobots that can interact with humans intimately. However, popularization of robots is not felt despite the current information environment in the modern ICT service environment and the 4th industrial revolution. Considering social interaction with users which is an important function of social robots, not only the technology of the robots but also other factors should be considered. The design elements of the robot are more important than other factors tomake consumers purchase essentially a social robot. In fact, existing studies on social robots are at the level of proposing "robot development methodology" or testing the effects provided by social robots to users in pieces. On the other hand, consumer emotions felt from the robot's appearance has an important influence in the process of forming user's perception, reasoning, evaluation and expectation. Furthermore, it can affect attitude toward robots and good feeling and performance reasoning, etc. Therefore, this study aims to verify the effect of appearance of social robot and consumer emotions on consumer's attitude toward social robot. At this time, a social robot design evaluation model is constructed by combining heterogeneous data from different sources. Specifically, the three quantitative indicator data for the appearance of social robots from the ABOT Database is included in the model. The consumer emotions of social robot design has been collected through (1) the existing design evaluation literature and (2) online buzzsuch as product reviews and blogs, (3) qualitative interviews for social robot design. Later, we collected the score of consumer emotions and attitudes toward various social robots through a large-scale consumer survey. First, we have derived the six major dimensions of consumer emotions for 23 pieces of detailed emotions through dimension reduction methodology. Then, statistical analysis was performed to verify the effect of derived consumer emotionson attitude toward social robots. Finally, the moderated regression analysis was performed to verify the effect of quantitatively collected indicators of social robot appearance on the relationship between consumer emotions and attitudes toward social robots. Interestingly, several significant moderation effects were identified, these effects are visualized with two-way interaction effect to interpret them from multidisciplinary perspectives. This study has theoretical contributions from the perspective of empirically verifying all stages from technical properties to consumer's emotion and attitudes toward social robots by linking the data from heterogeneous sources. It has practical significance that the result helps to develop the design guidelines based on consumer emotions in the design stage of social robot development.
This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.
Journal of agricultural medicine and community health
/
v.19
no.2
/
pp.141-158
/
1994
To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.
Journal of the Korean association of regional geographers
/
v.3
no.2
/
pp.37-87
/
1997
As a results of researches on the cultivation processes and settlement developments on the Mangyoung river valley as a whole could be have four 'Space-Time Continuity' through a [Origin-Destination] theory model. On a initial phases of cultivation, the cultivation process has been begun at mountain slopes and tributory plains in upper part of river-basin from Koryo Dynasty to early Chosun Dynasty. At first, indigenous peasants burned forests on the mountain slopes for making 'dryfield' for a cereal crops. Following population increase more stable food supply is necessary facets of life inducing a change production method into a 'wetfield' in tributory plains matching the population increase. First sedentary agriculture maybe initiated at this mountain slopes and tributory plains on upper part of river basin through a burning cultivation methods. Mountain slopes and tributory plains are become a Origin area in cultivation processes. It expanded from up to down through the valleys with 'a bits of land' fashion in a steady pace like a terraced fields expanded with bit by bit of land to downward. They expanded their land to the middle part of river basin in mid period of Chosun Dynasty with dike construction techniques on the river bank. Lower part of river cultivated with embankment building techniques in 1920s and then naturally expanded to the tidal marshes on the estuaries and river inlets of coastal areas. 'Pioneer fringes' are consolidated at there in modern times. Changes in landscapes are appeared it's own characters with each periods of time. Followings are results of study through the Mangyoung river valley as a whole. (1) Mountain slopes and tributory plains on the upper part of river are cultivated 'dryfields' by indigenous peasants with Burning cultivation methods at first and developed sedentary settlements at the edges of mountain slopes and on the river terrace near the fields. They formed a kind of 'periphery-located cluster type' of settlement. This type of settlement are become a prominant type in upper part of river basin. 'Dryfields' has been changed into a 'wetfields' at the narrow tributory plains by increasing population pressure in later time. These wetfields are supplied water by Weir and Ponds Irrigation System(제언수리방법). Streams on the tributory plains has been attracted wetfields besides of it and formed a [water+land] complex on it. 'Wetfields' are expanded from up to downward with a terraced land pattern(adder like pattern, 붕전) according to the gradient of valley. These periphery located settlements are formed a intimate ecological linkage with several sets of surroundings. Inner villages are expanded to Outer villages according to the expansion of arable lands into downward. (2) Mountain slopes and tributory plains expanded its territory to the alluvial deposited plains on the middle part of river valley with a urgent need of new land by population increase. This part of alluvial plains are cultivated mainly in mid period of Chosun Dynasty. Irrigation methods are changed into a Dike Construction Irrigation method(천방수리방법) for the control of floods. It has a trend to change the subjectives of cultivation from community-oriented one who constructed Bochang along tributories making rice paddies to local government authorities who could be gather large sums of capitals, techniques and labours for the big dike construction affairs. Settlements are advanced in the midst of plains avoiding friction of distances and formed a 'Centrallocated cluster type' of settlements. There occured a hierarchical structures of settlements in ranks and sizes according merits of water supply and transportation convenience at the broad plains. Big towns are developed at there. It strengthened a more prominant [water+land] complex along the canals. Ecological linkages between settlements and surroundings are shaded out into a tiny one in this area. (3) It is very necessary to get a modern technology of flood control at the rivers that have a large volume of water and broad width. The alluvial plains are remained in a wilderness phase until a technical level reached a large artificial levee construction ability that could protect the arable land from flood. Until that time on most of alluvial land at the lower part of river are remained a wilderness of overgrown with reeds in lacks of techniques to build a large-scale artificial levee along the riverbank. Cultivation processes are progressed in a large scale one by Japanese agricultural companies with [River Rennovation Project] of central government in 1920s. Large scale artificial levees are constructed along the riverbank. Subjectives of cultivation are changed from Korean peasants to Japanese agricultural companies and Korean peasants fell down as a tenant in a colonial situation of that time in Korea. They could not have any voices in planning of spatial structure and decreased their role in planning. Newly cultivated lands are reflected company's intensions, objectives and perspectives for achieving their goals for the sake of colonial power. Newly cultivated lands are planned into a regular Rectangular Block settings of rice paddies and implanted a large scale Bureaucratic-oriented Irrigation System on the cultivated plains. Every settlements are located in the midst of rice paddies with a Central located Cluster type of settlements. [water+land] complex along the canal system are more strengthened. Cultivated space has a characters of [I-IT] landscapes. (4) Artificial levees are connected into a coastal emnankment for a reclamation of broad tidal marshes on the estuaries and inlets of rivers in the colonial times. Subjectives of reclamation are enlarged into a big agricultural companies that could be acted a role as a big cultivator. After that time on most of reclamation project of tidal marshes are controlled by these agricultural companies formed by mostly Japanese capitalists. Reclaimed lands on the estuaries and river inlets are under hands of agricultural companies and all the spatial structures are formed by their intensions, objectives and perspectives. They constructed a Unit Farming Area for the sake of companies. Spatial structures are planned in a regular one with broad arable land for the rice production of rectangular blocks, regular canal systems and tank reservoir for the irrigation water supply into reclaimed lands. There developed a 'Central-located linear type' of settlements in midst of reclaimed land. These settlements are settled in a detail program upon this newly reclaimed land at once with a master plan and they have planned patterns in their distribution, building materials, location, and form. Ecological linkage between Newly settled settlemrnts and its surroundings are lost its colours and became a more artificial one by human-centred environment. [I-IT] landscapes are become more prominant. This region is a destination area of [Origin-Destination] theory model and formed a 'Pioneer Fringe'. It is a kind of pioneer front that could advance or retreat discontinously by physical conditions and socio-cultural conditions of that region.
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