• Journal of Korea Water Resources Association
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• v.56 no.4
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• pp.235-243
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• 2023

Due to the revision of the River Act and the enactment of the Act on the Investigation, Planning, and Management of Water Resources, a regular bed change survey has become mandatory and a system is being prepared such that local governments can manage water resources in a planned manner. Since the topography of a bed cannot be measured directly, it is indirectly measured via contact-type depth measurements such as level survey or using an echo sounder, which features a low spatial resolution and does not allow continuous surveying owing to constraints in data acquisition. Therefore, a depth measurement method using remote sensing-LiDAR or hyperspectral imaging-has recently been developed, which allows a wider area survey than the contact-type method as it acquires hyperspectral images from a lightweight hyperspectral sensor mounted on a frequently operating drone and by applying the optimal bandwidth ratio search algorithm to estimate the depth. In the existing hyperspectral remote sensing technique, specific physical quantities are analyzed after matching the hyperspectral image acquired by the drone's path to the image of a surface unit. Previous studies focus primarily on the application of this technology to measure the bathymetry of sandy rivers, whereas bed materials are rarely evaluated. In this study, the existing hyperspectral image-based water depth estimation technique is applied to rivers with vegetation, whereas spatio-temporal hyperspectral imaging and cross-sectional hyperspectral imaging are performed for two cases in the same area before and after vegetation is removed. The result shows that the water depth estimation in the absence of vegetation is more accurate, and in the presence of vegetation, the water depth is estimated by recognizing the height of vegetation as the bottom. In addition, highly accurate water depth estimation is achieved not only in conventional cross-sectional hyperspectral imaging, but also in spatio-temporal hyperspectral imaging. As such, the possibility of monitoring bed fluctuations (water depth fluctuation) using spatio-temporal hyperspectral imaging is confirmed.

• Journal of the Korean Society of Marine Environment & Safety
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• v.29 no.7
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• pp.902-909
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• 2023

This study evaluated the performance test of a small-sized LTE-Maritime(LTE-M) transceiver that was developed and promoted to expand the use of intelligent maritime traf ic information services led by the Ministry of Oceans and Fisheries with the aim of supporting the prevention of maritime accidents. Accoriding to statistics, approximately 30% of all marine accidents in Korean water occur with ships weighing less than 3 tons. Therefore, the blind spots of maritime safety must be supplemented through the development of small-sized transceivers. The small transceiver may be used in fishing boats that are active near coastal waters and in water leisure equipment near the coastline. Therefore, verifying whether sufficient performance and stable communication quality are provided is necessary, considering the environment of their real usage. In this study, we reviewed the communication quality goals of the LTE-M network and the performance requirements of small-sized transceivers suggested by the Ministry of Oceans and Fisheries, and proposed a test plan to appropriately evaluate the performance of small-sized transceivers. The validity of the proposed test method was verified for six real-sea areas with a high frequency of marine accidents. Consequently, the downlink and uplink transmission speeds of the small-sized LTE-M transceiver showed performances of 9 Mbps or more and 3 Mbps or more, respectively. In addition, using the coverage analysis system, coverage of more than 95% and 100% were confirmed in the intensive management zone (0-30 km) and interesting zone (30-50 km), respectively. The performance evaluation method and test results proposed in this paper are expected to be used as reference materials for verifying the performance of transceivers, contributing to the spread of government-promoted e-navigation services and small-sized transceivers.

• Journal of Venture Innovation
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• v.6 no.1
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• pp.181-198
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• 2023

This study aims to analyze the influence of organizational support perception of workers in medical institutions on intrinsic job motivation, and to check whether there is significance in the mediating effect of work-family conflict and work-family balance factors in this process. The results of empirical analysis through the questionnaire are as follows. First, it was confirmed that organizational support recognition had a significant positive effect on work-family balance as well as intrinsic job motivation, and work-family balance had a significant positive effect on intrinsic job motivation. Second, it was confirmed that organizational support recognition had a significant negative effect on work-family conflict, but work-family conflict had no significant influence on intrinsic job motivation. Third, in order to reduce job stress for medical institution workers, it is necessary to reduce job intensity, assign appropriate workload for ability. And in order to improve manpower operation and job efficiency, Job training and staffing in the right place are needed. Fourth, in order to improve positive organizational support perception and intrinsic job motivation, It is necessary to induce long-term service by providing support and institutional devices to increase attachment to the current job and recognize organizational problems as their own problems with various incentive systems. The limitations of this study and future research directions are as follows. First, it is believed that an expanded analysis of medical institution workers nationwide by region, gender, medical institution, academic, and income will not only provide more valuable results, but also evaluate the quality of medical services. Second, it is necessary to reflect the impact of the work-life balance support system on each employee depending on the environmental uncertainty or degree of competition in the hospital to which medical institution workers belong. Third, organizational support perception will be recognized differently depending on organizational culture and organizational type, and organizational size and work characteristics, working years, and work types, so it is necessary to reflect this. Fourth, it is necessary to analyze various new personnel management techniques such as hospital's organizational structure, job design, organizational support method, motivational approach, and personnel evaluation method in line with the recent change in the government's medical institution policy and the global business environment. It is also considered important to analyze by reflecting recent and near future medical trends.

• Journal of Intelligence and Information Systems
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• v.29 no.4
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• pp.271-286
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• 2023

The global COVID-19 pandemic has transformed face masks from situational accessories to indispensable items in daily life, prompting a shift in public perception and behavior. While the relaxation of mandatory mask-wearing regulations is underway, a significant number of individuals continue to embrace face masks, turning them into a form of personal expression and identity. This phenomenon has given rise to the Fashion Mask industry, characterized by unique designs and colors, experiencing rapid growth in the market. However, existing research on masks is predominantly focused on their efficacy in preventing infection or exploring attitudes during the pandemic, leaving a gap in understanding consumer preferences for mask design. We address this gap by investigating consumer perceptions and preferences for two prevalent mask designs-horizontal fold flat masks and vertical fold flat masks. Through a comprehensive approach involving surveys and eye-tracking experiments, we aim to unravel the subtle differences in how consumers perceive these designs. Our research questions focus on determining which design is more appealing and exploring the reasons behind any observed differences. The study's findings reveal a clear preference for vertical fold flat masks, which are not only preferred but also perceived as unique, sophisticated, three-dimensional, and lively. The eye-tracking analysis provides insights into the visual attention patterns associated with mask designs, highlighting the pivotal role of the fold line in influencing these patterns. This research contributes to the evolving understanding of masks as a fashion statement and provides valuable insights for manufacturers and marketers in the Fashion Mask industry. The results have implications beyond the pandemic, emphasizing the importance of design elements in sustaining consumer interest in face masks.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.18 no.5
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• pp.77-90
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• 2023

This study aims to investigate the potential of alternative credit assessment through Social Networking Sites (SNS) as a complementary tool to conventional loan review processes. It seeks to discern the impact of SNS usage characteristics and loan product attributes on credit loan repayment. To achieve this objective, we conducted a binomial logistic regression analysis examining the influence of SNS usage patterns, loan characteristics, and personal attributes on credit loan conditions, utilizing data from Company A's credit loan program, which integrates SNS data into its actual loan review processes. Our findings reveal several noteworthy insights. Firstly, with respect to profile photos that reflect users' personalities and individual characteristics, individuals who choose to upload photos directly connected to their personal lives, such as images of themselves, their private circles (e.g., family and friends), and photos depicting social activities like hobbies, which tend to be favored by individuals with extroverted tendencies, as well as character and humor-themed photos, which are typically favored by individuals with conscientious traits, demonstrate a higher propensity for diligently repaying credit loans. Conversely, the utilization of photos like landscapes or images concealing one's identity did not exhibit a statistically significant causal relationship with loan repayment. Furthermore, a positive correlation was observed between the extent of SNS usage and the likelihood of loan repayment. However, the level of SNS interaction did not exert a significant effect on the probability of loan repayment. This observation may be attributed to the passive nature of the interaction variable, which primarily involves expressing sympathy for other users' comments rather than generating original content. The study also unveiled the statistical significance of loan duration and the number of loans, representing key characteristics of loan portfolios, in influencing credit loan repayment. This underscores the importance of considering loan duration and the quantity of loans as crucial determinants in the design of microcredit products. Among the personal characteristic variables examined, only gender emerged as a significant factor. This implies that the loan program scrutinized in this analysis does not exhibit substantial discrimination based on age and credit scores, as its customer base predominantly consists of individuals in their twenties and thirties with low credit scores, who encounter challenges in securing loans from traditional financial institutions. This research stands out from prior studies by empirically exploring the relationship between SNS usage and credit loan repayment while incorporating variables not typically addressed in existing credit rating research, such as profile pictures. It underscores the significance of harnessing subjective, unstructured information from SNS for loan screening, offering the potential to mitigate the financial disadvantages faced by borrowers with low credit scores or those ensnared in short-term liquidity constraints due to limited credit history a group often referred to as "thin filers." By utilizing such information, these individuals can potentially reduce their credit costs, whereas they are supposed to accrue a more substantial financial history through credit transactions under conventional credit assessment system.

• Korean Journal of Heritage: History & Science
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• v.57 no.2
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• pp.144-166
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• 2024

The Cultural Heritage Committee is an important organization that has been deliberating on important matters related to the preservation of cultural properties in the Republic of Korea for more than 60 years since 1962. The Cultural Heritage Preservation Committee was active in 1961, which was a short period of about a year, but the minutes prepared at the time confirmed that it had the following meanings. First of all, legally, it was meaningful in that the concept of cultural property or intangible cultural property was used for the first time in Korea in laws and regulations on the term of office of professional members. These matters became the basis for the operation of the current Cultural Heritage Protection Act and the Cultural Heritage Committee. The following confirms that, unlike previously known activities, they were active despite political upheaval at the time. In spite of rapid regime change at the time, the committee had no change in its members, and the meetings continued without interruption. At that time, there was an exclusive relationship between different groups in relation to the preservation of cultural heritage, and this relationship was confirmed by the minutes that disappeared with the establishment of the Cultural Heritage Management Bureau, which integrated these groups. Finally, the form of the minutes prepared then shows the form of documentation at the time, where it is confirmed that the traditional documentation format is changing into a new form. It can be good research material in terms of modern and contemporary bibliography. As discussed earlier, the Cultural Heritage Conservation Committee of 1961 has historical significance in terms of legal and actual activities. The reason why the committee's activities were low valued is presumed to be that the minutes and related documents prepared at the time were not organized well due to the lack of a related administrative system. The minutes of the Cultural Heritage Conservation Committee record various facts about cultural heritage policies and decisions at that time. Therefore, analysis and research on these contents can reveal more facts about the cultural heritage policies and perceptions of that time.

• Journal of Digestive Cancer Research
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• v.8 no.1
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• pp.1-50
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• 2020

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

• Journal of Intelligence and Information Systems
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• v.27 no.1
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• pp.83-102
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• 2021

The government recently announced various policies for developing big-data and artificial intelligence fields to provide a great opportunity to the public with respect to disclosure of high-quality data within public institutions. KSURE(Korea Trade Insurance Corporation) is a major public institution for financial policy in Korea, and thus the company is strongly committed to backing export companies with various systems. Nevertheless, there are still fewer cases of realized business model based on big-data analyses. In this situation, this paper aims to develop a new business model which can be applied to an ex-ante prediction for the likelihood of the insurance accident of credit guarantee. We utilize internal data from KSURE which supports export companies in Korea and apply machine learning models. Then, we conduct performance comparison among the predictive models including Logistic Regression, Random Forest, XGBoost, LightGBM, and DNN(Deep Neural Network). For decades, many researchers have tried to find better models which can help to predict bankruptcy since the ex-ante prediction is crucial for corporate managers, investors, creditors, and other stakeholders. The development of the prediction for financial distress or bankruptcy was originated from Smith(1930), Fitzpatrick(1932), or Merwin(1942). One of the most famous models is the Altman's Z-score model(Altman, 1968) which was based on the multiple discriminant analysis. This model is widely used in both research and practice by this time. The author suggests the score model that utilizes five key financial ratios to predict the probability of bankruptcy in the next two years. Ohlson(1980) introduces logit model to complement some limitations of previous models. Furthermore, Elmer and Borowski(1988) develop and examine a rule-based, automated system which conducts the financial analysis of savings and loans. Since the 1980s, researchers in Korea have started to examine analyses on the prediction of financial distress or bankruptcy. Kim(1987) analyzes financial ratios and develops the prediction model. Also, Han et al.(1995, 1996, 1997, 2003, 2005, 2006) construct the prediction model using various techniques including artificial neural network. Yang(1996) introduces multiple discriminant analysis and logit model. Besides, Kim and Kim(2001) utilize artificial neural network techniques for ex-ante prediction of insolvent enterprises. After that, many scholars have been trying to predict financial distress or bankruptcy more precisely based on diverse models such as Random Forest or SVM. One major distinction of our research from the previous research is that we focus on examining the predicted probability of default for each sample case, not only on investigating the classification accuracy of each model for the entire sample. Most predictive models in this paper show that the level of the accuracy of classification is about 70% based on the entire sample. To be specific, LightGBM model shows the highest accuracy of 71.1% and Logit model indicates the lowest accuracy of 69%. However, we confirm that there are open to multiple interpretations. In the context of the business, we have to put more emphasis on efforts to minimize type 2 error which causes more harmful operating losses for the guaranty company. Thus, we also compare the classification accuracy by splitting predicted probability of the default into ten equal intervals. When we examine the classification accuracy for each interval, Logit model has the highest accuracy of 100% for 0~10% of the predicted probability of the default, however, Logit model has a relatively lower accuracy of 61.5% for 90~100% of the predicted probability of the default. On the other hand, Random Forest, XGBoost, LightGBM, and DNN indicate more desirable results since they indicate a higher level of accuracy for both 0~10% and 90~100% of the predicted probability of the default but have a lower level of accuracy around 50% of the predicted probability of the default. When it comes to the distribution of samples for each predicted probability of the default, both LightGBM and XGBoost models have a relatively large number of samples for both 0~10% and 90~100% of the predicted probability of the default. Although Random Forest model has an advantage with regard to the perspective of classification accuracy with small number of cases, LightGBM or XGBoost could become a more desirable model since they classify large number of cases into the two extreme intervals of the predicted probability of the default, even allowing for their relatively low classification accuracy. Considering the importance of type 2 error and total prediction accuracy, XGBoost and DNN show superior performance. Next, Random Forest and LightGBM show good results, but logistic regression shows the worst performance. However, each predictive model has a comparative advantage in terms of various evaluation standards. For instance, Random Forest model shows almost 100% accuracy for samples which are expected to have a high level of the probability of default. Collectively, we can construct more comprehensive ensemble models which contain multiple classification machine learning models and conduct majority voting for maximizing its overall performance.

• Proceedings of the KOR-KST Conference
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• 1995.02a
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• pp.101-113
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• 1995

The objective of this research is to test the feasibility of developing a statewide truck traffic forecasting methodology for Wisconsin by using Origin-Destination surveys, traffic counts, classification counts, and other data that are routinely collected by the Wisconsin Department of Transportation (WisDOT). Development of a feasible model will permit estimation of future truck traffic for every major link in the network. This will provide the basis for improved estimation of future pavement deterioration. Pavement damage rises exponentially as axle weight increases, and trucks are responsible for most of the traffic-induced damage to pavement. Consequently, forecasts of truck traffic are critical to pavement management systems. The pavement Management Decision Supporting System (PMDSS) prepared by WisDOT in May 1990 combines pavement inventory and performance data with a knowledge base consisting of rules for evaluation, problem identification and rehabilitation recommendation. Without a r.easonable truck traffic forecasting methodology, PMDSS is not able to project pavement performance trends in order to make assessment and recommendations in the future years. However, none of WisDOT's existing forecasting methodologies has been designed specifically for predicting truck movements on a statewide highway network. For this research, the Origin-Destination survey data avaiiable from WisDOT, including two stateline areas, one county, and five cities, are analyzed and the zone-to'||'&'||'not;zone truck trip tables are developed. The resulting Origin-Destination Trip Length Frequency (00 TLF) distributions by trip type are applied to the Gravity Model (GM) for comparison with comparable TLFs from the GM. The gravity model is calibrated to obtain friction factor curves for the three trip types, Internal-Internal (I-I), Internal-External (I-E), and External-External (E-E). ~oth "macro-scale" calibration and "micro-scale" calibration are performed. The comparison of the statewide GM TLF with the 00 TLF for the macro-scale calibration does not provide suitable results because the available 00 survey data do not represent an unbiased sample of statewide truck trips. For the "micro-scale" calibration, "partial" GM trip tables that correspond to the 00 survey trip tables are extracted from the full statewide GM trip table. These "partial" GM trip tables are then merged and a partial GM TLF is created. The GM friction factor curves are adjusted until the partial GM TLF matches the 00 TLF. Three friction factor curves, one for each trip type, resulting from the micro-scale calibration produce a reasonable GM truck trip model. A key methodological issue for GM. calibration involves the use of multiple friction factor curves versus a single friction factor curve for each trip type in order to estimate truck trips with reasonable accuracy. A single friction factor curve for each of the three trip types was found to reproduce the 00 TLFs from the calibration data base. Given the very limited trip generation data available for this research, additional refinement of the gravity model using multiple mction factor curves for each trip type was not warranted. In the traditional urban transportation planning studies, the zonal trip productions and attractions and region-wide OD TLFs are available. However, for this research, the information available for the development .of the GM model is limited to Ground Counts (GC) and a limited set ofOD TLFs. The GM is calibrated using the limited OD data, but the OD data are not adequate to obtain good estimates of truck trip productions and attractions .. Consequently, zonal productions and attractions are estimated using zonal population as a first approximation. Then, Selected Link based (SELINK) analyses are used to adjust the productions and attractions and possibly recalibrate the GM. The SELINK adjustment process involves identifying the origins and destinations of all truck trips that are assigned to a specified "selected link" as the result of a standard traffic assignment. A link adjustment factor is computed as the ratio of the actual volume for the link (ground count) to the total assigned volume. This link adjustment factor is then applied to all of the origin and destination zones of the trips using that "selected link". Selected link based analyses are conducted by using both 16 selected links and 32 selected links. The result of SELINK analysis by u~ing 32 selected links provides the least %RMSE in the screenline volume analysis. In addition, the stability of the GM truck estimating model is preserved by using 32 selected links with three SELINK adjustments, that is, the GM remains calibrated despite substantial changes in the input productions and attractions. The coverage of zones provided by 32 selected links is satisfactory. Increasing the number of repetitions beyond four is not reasonable because the stability of GM model in reproducing the OD TLF reaches its limits. The total volume of truck traffic captured by 32 selected links is 107% of total trip productions. But more importantly, ~ELINK adjustment factors for all of the zones can be computed. Evaluation of the travel demand model resulting from the SELINK adjustments is conducted by using screenline volume analysis, functional class and route specific volume analysis, area specific volume analysis, production and attraction analysis, and Vehicle Miles of Travel (VMT) analysis. Screenline volume analysis by using four screenlines with 28 check points are used for evaluation of the adequacy of the overall model. The total trucks crossing the screenlines are compared to the ground count totals. L V/GC ratios of 0.958 by using 32 selected links and 1.001 by using 16 selected links are obtained. The %RM:SE for the four screenlines is inversely proportional to the average ground count totals by screenline .. The magnitude of %RM:SE for the four screenlines resulting from the fourth and last GM run by using 32 and 16 selected links is 22% and 31 % respectively. These results are similar to the overall %RMSE achieved for the 32 and 16 selected links themselves of 19% and 33% respectively. This implies that the SELINICanalysis results are reasonable for all sections of the state.Functional class and route specific volume analysis is possible by using the available 154 classification count check points. The truck traffic crossing the Interstate highways (ISH) with 37 check points, the US highways (USH) with 50 check points, and the State highways (STH) with 67 check points is compared to the actual ground count totals. The magnitude of the overall link volume to ground count ratio by route does not provide any specific pattern of over or underestimate. However, the %R11SE for the ISH shows the least value while that for the STH shows the largest value. This pattern is consistent with the screenline analysis and the overall relationship between %RMSE and ground count volume groups. Area specific volume analysis provides another broad statewide measure of the performance of the overall model. The truck traffic in the North area with 26 check points, the West area with 36 check points, the East area with 29 check points, and the South area with 64 check points are compared to the actual ground count totals. The four areas show similar results. No specific patterns in the L V/GC ratio by area are found. In addition, the %RMSE is computed for each of the four areas. The %RMSEs for the North, West, East, and South areas are 92%, 49%, 27%, and 35% respectively, whereas, the average ground counts are 481, 1383, 1532, and 3154 respectively. As for the screenline and volume range analyses, the %RMSE is inversely related to average link volume. 'The SELINK adjustments of productions and attractions resulted in a very substantial reduction in the total in-state zonal productions and attractions. The initial in-state zonal trip generation model can now be revised with a new trip production's trip rate (total adjusted productions/total population) and a new trip attraction's trip rate. Revised zonal production and attraction adjustment factors can then be developed that only reflect the impact of the SELINK adjustments that cause mcreases or , decreases from the revised zonal estimate of productions and attractions. Analysis of the revised production adjustment factors is conducted by plotting the factors on the state map. The east area of the state including the counties of Brown, Outagamie, Shawano, Wmnebago, Fond du Lac, Marathon shows comparatively large values of the revised adjustment factors. Overall, both small and large values of the revised adjustment factors are scattered around Wisconsin. This suggests that more independent variables beyond just 226; population are needed for the development of the heavy truck trip generation model. More independent variables including zonal employment data (office employees and manufacturing employees) by industry type, zonal private trucks 226; owned and zonal income data which are not available currently should be considered. A plot of frequency distribution of the in-state zones as a function of the revised production and attraction adjustment factors shows the overall " adjustment resulting from the SELINK analysis process. Overall, the revised SELINK adjustments show that the productions for many zones are reduced by, a factor of 0.5 to 0.8 while the productions for ~ relatively few zones are increased by factors from 1.1 to 4 with most of the factors in the 3.0 range. No obvious explanation for the frequency distribution could be found. The revised SELINK adjustments overall appear to be reasonable. The heavy truck VMT analysis is conducted by comparing the 1990 heavy truck VMT that is forecasted by the GM truck forecasting model, 2.975 billions, with the WisDOT computed data. This gives an estimate that is 18.3% less than the WisDOT computation of 3.642 billions of VMT. The WisDOT estimates are based on the sampling the link volumes for USH, 8TH, and CTH. This implies potential error in sampling the average link volume. The WisDOT estimate of heavy truck VMT cannot be tabulated by the three trip types, I-I, I-E ('||'&'||'pound;-I), and E-E. In contrast, the GM forecasting model shows that the proportion ofE-E VMT out of total VMT is 21.24%. In addition, tabulation of heavy truck VMT by route functional class shows that the proportion of truck traffic traversing the freeways and expressways is 76.5%. Only 14.1% of total freeway truck traffic is I-I trips, while 80% of total collector truck traffic is I-I trips. This implies that freeways are traversed mainly by I-E and E-E truck traffic while collectors are used mainly by I-I truck traffic. Other tabulations such as average heavy truck speed by trip type, average travel distance by trip type and the VMT distribution by trip type, route functional class and travel speed are useful information for highway planners to understand the characteristics of statewide heavy truck trip patternS. Heavy truck volumes for the target year 2010 are forecasted by using the GM truck forecasting model. Four scenarios are used. Fo~ better forecasting, ground count- based segment adjustment factors are developed and applied. ISH 90 '||'&'||' 94 and USH 41 are used as example routes. The forecasting results by using the ground count-based segment adjustment factors are satisfactory for long range planning purposes, but additional ground counts would be useful for USH 41. Sensitivity analysis provides estimates of the impacts of the alternative growth rates including information about changes in the trip types using key routes. The network'||'&'||'not;based GMcan easily model scenarios with different rates of growth in rural versus . . urban areas, small versus large cities, and in-state zones versus external stations. cities, and in-state zones versus external stations.

• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

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.