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Lecompte Procedure in Complex Congenital Heart Diseases (선천성 복잡 심기형에서의 Lecompte 술식의 유용성 및 임상적용에 관한 연구)

  • Kim, Yong-Jin;Kim, Kyung-Hwan;Lee, Suk-Jae;Song, Hyun;Oh, Sam-Se;Lee, Jeong-Ryul;Rho, Joon-Ryang;Suh, Kyung-Phill
    • Journal of Chest Surgery
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    • v.31 no.7
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    • pp.660-667
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    • 1998
  • Background: This study is to evaluate the effectiveness and application of Lecompte procedure as a treatment for various complex cardiac anomalies with pulmonary outflow tract obstruction. Methods: Between July 1988 and December 1997, 44 patients underwent Lecompte procedure in Seoul National University Children's Hospital. The male to female ratio was 24 to 20 and the mean age was 29.2 months(range, 3 to 83). Of these patients, 28(63.6%) had transposition of great arteries with ventricular septal defect and pulmonary stenosis(or pulmonary atresia), 14(31.8%) had double outlet right ventricle with pulmonary stenosis(or pulmonary atresia), and so on. The principles of the technique are 1) extension of the ventricular septal defect or conal resection, 2) construction of a intracardiac tunnel connecting the left ventricle to the aorta, and 3) direct connection, without a prosthetic conduit, of the pulmonary trunk to the right ventricle. Results: There were 3 in-hospital deaths and their causes were sustained hypoxia, myocardial failure, and sepsis, respectively. There was 1 late death due to sepsis. Reoperations were performed in 6 patients who had pulmonary outflow tract obstructions(4 cases), residual muscular ventricular septal defect(1 case), and recurrent septic vegetation(1 case). The cumulative survival rates by the Kaplan-Meier method were 92.7%, 92.7%, and 92.7% at 1, 2, and over 4 years. The reoperation free survival rates were 92.7%, 92.7%, and 70.2% at 1, 3, and over 5 years. Among the risk factors for the operative death, aortic cross clamping time had statistical significance(p<0.05) and all the risk factors for the recurrent pulmonary stenosis such as age, pulmonary artery index, and materials used for the pulmonary outflow tract reconstruction had no statistical significance(p>0.05). Conclusions: Our review suggests that Lecompte procedure is an effective treatment modality for various complex cardiac anomalies with pulmonary outflow tract obstruction. Repair in early age is possible and the rates of mortality and morbidity are also acceptable.

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Syllabus Design and Pronunciation Teaching

  • Amakawa, Yukiko
    • Proceedings of the KSPS conference
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    • 2000.07a
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    • pp.235-240
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    • 2000
  • In the age of global communication, more human exchange is extended at the grass-roots level. In the old days, language policy and language planning was based on one nation-state with one language. But high waves of globalizaiton have allowed extended human flow of exchange beyond one's national border on a daily basis. Under such circumstances, homogeneity in Japan may not allow Japanese to speak and communicate only in Japanese and only with Japanese people. In Japan, an advisory report was made to the Ministry of Education in June 1996 about what education should be like in the 21st century. In this report, an introduction of English at public elementary schools was for the first time made. A basic policy of English instruction at the elementary school level was revealed. With this concept, English instruction is not required at the elementary school level but each school has their own choice of introducing English as their curriculum starting April 2002. As Baker, Colin (1996) indicates the age of three as being the threshold diving a child becoming bilingual naturally or by formal instruction. Threre is a movement towards making second language acquisition more naturalistic in an educational setting, developing communicative competence in a more or less formal way. From the lesson of the Canadian immersion success, Genesee (1987) stresses the importance of early language instruction. It is clear that from a psycho-linguistic perspective, most children acquire basic communication skills in their first language apparently effortlessly and without systematic and formal instruction during the first six or seven years of life. This innate capacity diminishes with age, thereby making language learning increasingly difficult. The author, being a returnee, experienced considerable difficulty acquiring L2, and especially achieving native-like competence. There will be many hurdles to conquer until Japanese students are able to reach at least a communicative level in English. It has been mentioned that English is not taught to clear the college entrance examination, but to communicate. However, Japanese college entrance examination still makes students focus more on the grammar-translation method. This is expected to shift to a more communication stressed approach. Japan does not have to aim at becoming an official bilingual country, but at least communicative English should be taught at every level in school Mito College is a small two-year co-ed college in Japan. Students at Mito College are basically notgood at English. It has only one department for business and economics, and English is required for all freshmen. It is necessary for me to make my classes enjoyable and attractive so that students can at least get motivated to learn English. My major target is communicative English so that students may be prepared to use English in various business settings. As an experiment to introduce more communicative English, the author has made the following syllabus design. This program aims at training students speak and enjoy English. 90-minute class (only 190-minute session per week is most common in Japanese colleges) is divided into two: The first half is to train students orally using Graded Direct Method. The latter half uses different materials each time so that students can learn and enjoy English culture and language simultaneously. There are no quizes or examinations in my one-academic year program. However, all students are required to make an original English poem by the end of the spring semester. 2-6 students work together in a group on one poem. Students coming to Mito College, Japan have one of the lowest English levels in all of Japan. However, an attached example of one poem made by a group shows that students can improve their creativity as long as they are kept encouraged. At the end of the fall semester, all students are then required individually to make a 3-minute original English speech. An example of that speech contest will be presented at the Convention in Seoul.

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A Study on the Costumes of the Characters of Higyongru Banghwoedo (<희경루방회도(喜慶樓榜會圖)> 속 인물들의 복식 고찰)

  • Bae, Jin-Hee;Lee, Eun-Joo
    • Korean Journal of Heritage: History & Science
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    • v.51 no.4
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    • pp.44-65
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    • 2018
  • This study examined the costumes of the characters in the painting titled Hig yongru Banghwoedo, which was designated as National Treasure No. 1879 in September 2015, and is currently kept in the Dongguk University Museum. The painting depicts a social gathering of Joseon aristocrats held at the higyongru, or watch tower, of the Gwangjumok, a government office, in 1567. It is characterized by the delicate illustration of the government officials, the main characters of the gathering, and the hyangri, ajeon, najang, chorye, akgong, and yeogi, the lower-class employees of the office. In order to investigate the costumes they wore, diverse materials including literature, costume artifacts, and paintings were used as reference sources. The scope of the study was limited to the characters' headdress and gown, and the accessories attached to the former. The study of men's clothing revealed that officials wore a samo and a red dalryeong as basic attire. In addition, it is presumed that they wore a belt indicating their official rank in the hierarchy, and a pair of black shoes. Retired officials wore a heuklip wrapped in horsehair or silk fabric with a red jing-nyeong and a doah. The hyangri wore a heukjukbanglip on their head, as well as a white jing-nyeong and a belted doah. In the Goryeo period, the banglip was a type of official headdress worn by members of the aristocratic elite ranked immediately below the king, but in Joseon it was demoted as the official headgear of the hyangri class, which was confirmed through Higyongru Banghwoedo. The ajeon wore a heuklip on their head, and a white jing-nyeong and a doah at the waist. As a rule, the najang wore a chogun on the head, and a banbieui on cheolrik and chungmokdai, but the najang in Higyongru Banghwoedo are depicted wearing a chogun and a cheolrik without a banbieui. Also, the chorye wore a heuklip wrapped in hemp cloth with a red cheolrik, whereas the akgong wore a somoja and a red cheolrik. Female entertainers, both adults and children, are depicted in the painting as either serving the aristocrats, dancing, or playing a musical instrument, wearing their hair in a voluminous, round, high bun, and dressed in a red daiyo, a hwangjangsam with a straight or reclined collar, and a belt. Notably, the donggi, i.e. young gisaeng, are shown wearing their hair in two short braids, and ddressed in a red gown with a y-shaped collar, or po.

Exposure and Risk Assessments of Multimedia of Arsenic in the Environment (환경 중 비소의 매체통합 노출평가 및 위해성평가 연구)

  • Sim, Ki-Tae;Kim, Dong-Hoon;Lee, Jaewoo;Lee, Chae-Hong;Park, Soyeon;Seok, Kwang-Seol;Kim, Younghee
    • Journal of Environmental Impact Assessment
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    • v.28 no.2
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    • pp.152-168
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    • 2019
  • The element arsenic, which is abundant in the Earth's crust, is used for various industrial purposes including materials for disease treatment and household goods. Various human activities, such as the disposal of soil waste, metal mining and smelting, and combustion of fossil fuels, have caused the pollution of the environment with arsenic. Recently, guidelines for arsenic in rice have been adopted by the Korean ministry of food and drug safety to prevent health risks based on rice consumption. Because of the exposure to arsenic and its accumulation in the human body through various channels, such as air inhalation, skin contact, ingestion of drinking water, and food consumption, integrated multimedia risk assessment is required to adopt appropriate risk management policies. Therefore, integrated human health risk assessment was carried out in this study using integrated exposure assessment based on multimedia (e.g., air, water, and soil) and multi-route (e.g., oral, inhalation, and dermal) scenarios. The results show that oral uptake via drinking water is the most common pathway of arsenic into the human body, accounting for 57%-96% of the total arsenic exposure. Among various age groups, the highest exposures to arsenic were observed in infants because the body weight of infants is low and the surface areas of infant bodies are large. Based on the results of the exposure assessment, the cancer and non-cancer risks were calculated. The cancer risk for CTE and RME is in the range of 2.3E-05 to 6.7E-05 and thus is negligible because it does not exceed the cancer probability of 1.0E-04 for all age groups. On the other hand, the cancer risk for RME varies from 6.4E-05 to 1.8E-04 and from 1.3E-04 to 1.8E-04 for infants and preschool children, exceeding the excess cancer risk of 1.0E-04. The non-cancer risks range from 5.4E-02 to 1.9E-01 and from 1.5E-01 to 6.8E-01, respectively. They do not exceed the hazard index 1 for all scenarios and all ages.

Glomerular Filtration Rate Test Methods and Guidelines (Glomerular Filtration Rate 검사방법 및 가이드라인)

  • Park, Min-Ho;Lee, Ha-Young;Ryu, Hwa-Jin;Yoo, Tae-Min;Noh, Gyeong-Woon
    • The Korean Journal of Nuclear Medicine Technology
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    • v.22 no.2
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    • pp.97-100
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    • 2018
  • Purpose The glomerular filtration rate (GFR) test is an important indicator of glomerular filtration and has been used to test renal function and the extent of its function. The GFR test is performed by intravenous injection of radioactive medicines made of $^{51}Cr$-EDTA, and blood concentration is measured by taking blood according to the elapsed time. also, PET-CT, bone scan, transfusion and so on will affect the outcome. Therefore, we will improve the quality of the test by providing guidelines for the GFR test for more accurate testing. Materials and Methods 5 mL of physiological saline solution and 2 mL of $^{51}Cr$-EDTA solution are used to make 5 mL of the radiopharmaceutical solution to be injected into the patient. First, the syringe weight is measured before the injection, and then the radioactive medicine is injected into the patient's vein and the syringe weight is measured after the injection. Blood sampling is performed twice in total. In adults, blood is collected 3 hours / 5 hours after injection and in children 2 hours / 5 hours after injection. The blood sample is centrifuged at 3300 rpm for 5 minutes. Standard solution is prepared by filling diluent water up to the scale indicated in the 200-mL volumetric flask, discarding $500{\mu}L$, injecting $500{\mu}L$ of GFR reagent and mixing well. $500{\mu}L$ each of the standard solution is dispensed into two test tubes, and $500{\mu}L$ of each of the plasma samples collected in time is dispensed into two test tubes and measured with a Cobra Counter. Results At present, the reference range applied in this study is $119.5{\pm}30.3ml/min/1.73m2$ for males and $125.2{\pm}28.2ml/min/1.73m^2$ for females. Conclusion The GFR test is conducted using radioactive medical products. GFR testing is performed as a scheduled test, but PET-CT, dialysis and transfusion, which may affect GFR testing, may be scheduled during GFR testing. Therefore, we could get accurate GFR test results by notifying the ward and department beforehand when booking.

A Study on Coming of Age, Wedding, Funeral, and Ancestral Rites Found in 『Hajaeilgi』 (『하재일기』에 나타난 관·혼·상·제례 연구)

  • Song, Jae-Yong
    • (The)Study of the Eastern Classic
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    • no.70
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    • pp.435-466
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    • 2018
  • "Hajaeilgi (荷齋日記)" was written by Ji Gyu-sik, a gongin of Saongwon (司饔院)'s branch, almost everyday for 20 years and 7 months from January 1st, 1891 until the leap month of June 29th, 1911. It deals with many different areas including domestic and foreign circumstances, custom, rituals, all the affairs related to the branch, and also everyday life. Particularly, Ji Gyu-sik did not belong to the yangban class, and we can hardly find diaries written by such class' people. Here, what this author pays attention to among the things written in "Hajaeilgi" is the contents about rituals, especially coming of age, wedding, funeral and ancestral rites. Ji Gyu-sik did write in his "Hajaeilgi" about coming of age, wedding, funeral and ancestral rites that were actually performed then as a person not belonging to the yangban class. Such diaries are very rare, and its value is highly appreciated as a material. Particularly, from the late 19th to the early 20th century of this author focuses on the a study of coming of age, wedding, funeral and ancestral rites as we can see some aspects about it from his diary. Coming-of-age rites were carried out in the first month of the year generally, and in this period, we can see the transformation of their performing period as it was diversified then. This was not exceptional in yangban families. About wedding, while it was discussed, it came to be canceled more often than before maybe because they were going through the process of enlightenment then. It seems that choosing the day was not done in the bride's family always. Jungin or commoners had a weeding in the bride's house, but when it was needed, it was also performed in the groom's house. Ji Gyu-sik followed the traditional wedding procedure for his children rather faithfully, but it was applied flexibly according to the two families' situations or conditions. Ignoring the traditional manners, they had a wedding in the period of mourning or performed a wedding in the groom's house bringing the bride there. It seems that this was related to the decline of Confucian order in the society in the process of modernization. Also, the form of donations changed, too. Gradually, it was altered to the form of money gifts. Moreover, unlike before, divorcing seems to have been allowed then. Remarriage or divorce was the custom transformed from before. Funeral rites had different durations from death up to balin (carrying out a bier for burial) and hagwan (lowering a coffin into the grave), and so it means that they also went through transformation. Sa-daebu used usually 3 months but here was 7 days from death to balin normally, but it seems that there were yangban families not following it. The traces of 3-iljang (burial on the third day after death) most commonly found these days and chowoo jaewoo samwooje can be also found in "Hajaeilgi". Such materials are, in fact, very highly evaluated nowadays. Meanwhile, donations also changed gradually to the form of money. Regarding ancestral rites, time for memorial service was not fixed. Ji Gyu-sik did not follow jaegye (齋戒) before carrying out gijesa, and in some worse case, he went to pub the day before the memorial service to meet his lover or drink. This is somewhat different from the practice of yangban sadaebu then. Even after entering Christianity, Ji Gyu-sik performed memorial service, and after joining Cheondogyo, he did it, too. Meanwhile, there were some exceptions, but in Hansik or Chuseok, Ji Gyu-sik performed charye (myoje) before the tomb in person or sent his little brother or son to do it. But we cannot find the contents that tell us Ji Gyu-sik carried out myoje in October. Ji Gyu-sik performed saengiljesa calling it saengsincharye almost every year for his late father. But it is noticeable that he performed saengsincharye and memorial service separately, too, occasionally. The gijesa, charye, myoje, and saengsincharye carried out by jungin family from Gyeonggi Gwangju around the time that the status system was abolished and the Japanese Empire took power may have been rather different and less strict than yangban family's practice of ancestral rites; however, it is significant that we can see with it the aspects of ancestral rites performed in family not yangban. As described above, the contents about the a study of coming of age, wedding, funeral and ancestral rites found in "Hajaeilgi" are equipped with great value as material and meaningful in the perspective of forklore.

An Analysis of Determinants of Health Knowledge, Attitude and Practice of Housewives in Korea (한국부인의 보건지식, 태도 및 실천에 영향을 미치는 제요인분석)

  • 남철현
    • Korean Journal of Health Education and Promotion
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    • v.2 no.1
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    • pp.3-50
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    • 1984
  • The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.

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Comparative Analysis of Community Health Practitioner's Activities and Primary Health Post Management Before and After Officialization of Community Health practitioner (보건진료원의 정규직화 전과 후의 보건진료원 활동 및 보건진료소 관리운영체계의 비교 분석)

  • Yun, Suk-Ok;Jung, Moon-Sook
    • Journal of agricultural medicine and community health
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    • v.19 no.2
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    • pp.141-158
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    • 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.

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