Comparisons of food security, dietary behaviors and nutrient intakes between adult North Korean Refugees in South Korea and South Koreans

BACKGROUND/OBJECTIVES: North Korean refugees (NKRs) in South Korea are a unique population as they must adapt in a new country with similar cultural traits but different social, political, and economic systems, but little research has been conducted on diet and nutrition in this population. This study examined food security, dietary behaviors, and nutrient intakes among adult NKRs living in South Korea and compared them to those of South Koreans.SUBJECTS/METHODS: The subjects were 139 adult NKRs (25 men, 114 women) living in the Seoul metropolitan area, and 417 age- and sex-matched South Korean controls (SKCs; 75 men, 342 women) selected from the Korea National Health and Nutrition Examination Survey (KNHANES). Food security and dietary behaviors (meal skipping, eating-out, meals with family, nutrition education and counseling, and nutrition label knowledge and utilization) were obtained using self-administered questionnaires. Nutrient intakes were assessed by 24-hr recall. The statistical analysis was performed using IBM SPSS ver. 23.0.RESULTS: In South Korea, food security had improved over the previous 12 months, but remained significantly poorer for NKR women than SKC women. Meal skipping was three times more frequent than for SKCs and eating-out was rare. Average energy intake was 1,509 kcal for NKR men and 1,344 kcal for NKR women, which was lower than those of SKCs (2,412 kcal and 1,789 kcal, respectively). Significantly more NKRs (men 24.0%, women 21.9%) showed simultaneously deficient intake in energy, calcium, iron, vitamin A, and riboflavin than SKCs (men 2.7% (P = 0.003), women 7.0% (P < 0.001)). NKR women had a significantly higher index of nutrient quality (INQ) for some nutrients than SK women.CONCLUSIONS: This study reports significant differences in food security, dietary behaviors, and nutrient intakes between NKRs and SKCs. Generally, NKRs reported lower intakes despite improved food security, but relatively good INQs across nutrients. Further research is needed to understand processes of food choice and consumption among NKRs to provide appropriate support aimed at improving diets.

Hermeneutic Phenomenological Study on the Experiences of Employment of Married North Korean Women Defectors Rearing Children

PURPOSE: This study aimed to understand the experiences of married North Korean women's child-rearing, working lives, and their home and work environment in depth.METHODS: This study adopted van Manen's hermeneutic phenomenological method to qualitatively analyze data. The participants were 8 married North Korean women defectors. Data were collected through in-depth interviews and observations from July 4 to August 20, 2018.RESULTS: Nine essential themes emerged: more personal challenges after overcoming a life-threatening crisis; hopes of firmly settling in this land; the wound from the north, which chased them here; a body that becomes stronger through hardship; being stuck in a past full of anxiety and pain; the present is full of hope; hope for the future; sense of alienation from coworkers that cannot be overcome; and sense of power to endure an exhausting work life.CONCLUSION: This study provided a broader understanding of the life and experiences of married women from North Korea. It highlights the need for nurses to recognize their importance in nursing care. The study also suggests that academic and practical approaches for nursing, and basic data for a nursing intervention for married women from North Korea be provided. The study findings can be used as a basis for preparing a national policy that will help North Korean defectors to find employment and gain stability.

An Estimation of Supply and Demand for Primary Healthcare Nursing Workforce in the North Korean Region after Korean Reunification / 간호행정학회지

PURPOSE: This study was done to estimate supply and demand for nursing workforce to provide community-based primary healthcare in the North Korean region to cost-efficiently narrow the health gap between the two Koreas in case of a Korean reunification. METHODS: To understand the nursing education system and current state of nursing workforce in North Korea, the authors interviewed six North Korean defectors who had worked as nurses in North Korea. Based on the interview results and literature review, the supply and demand for the primary healthcare nursing workforce that would be needed after Korean reunification were estimated RESULTS: Currently, a total of 2,100 to 2,700 North Korean nurses were estimated to have graduated from nursing schools with a 2 year curriculum or completed 6-month military nurse training courses every year. The projected number of nurses in demand to provide primary health care ranged from 84,160 to 105,200 and the shortage would be between 31,586 and 52,626. CONCLUSION: An active utilization of the North Korean nursing workforce to improve the health of North Koreans after reunification will be the best way to reduce the reunification cost which will be inflicted mainly on South Korea.

Nursing College Life Experiences of North Korean Defectors

PURPOSE: The purpose of this study is to understand nursing college life experiences of North Korean Defectors and identify their meanings. METHODS: The study collected data through individual in-depth interviews among six undergraduates or graduates from nursing colleges, using phenomenological research methodology of Colaizzi-one of qualitative research approaches. RESULTS: Six categories drawn as a result of research include ‘Be bumped against hard reality wall’, ‘Bondage of discrimination and prejudice’, ‘Endure and stand with strength of faith’, ‘Myself grown up along with work’, ‘Becoming one amid differences’, and ‘Stepping towards unification’. CONCLUSION: The result of this study would contribute to understanding academic and interpersonal difficulties North Korean defectors might experience at nursing colleges. And it may also help people to learn that they would play an important role in integration of the nursing fields of South and North Korea as well as the nation's unification. Along the way, the results of the study could be basic data to establish national policy helping North Korean defectors adapt to nursing college life, and develop the supporting system of colleges as well as setting up appropriate supports and measures from the perspective of the nursing field.

Effects of a Program to Promote Multicultural Awareness and Multicultural Efficacy toward North Korean Defectors for Nursing Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to develop a program to improve the cultural competence of nursing students related to North Korean defectors and to investigate the effectiveness of the program. METHODS: There were 36 nursing students in the experimental group and 30 in the control group, who were recruited from a university in I-city, Korea. A Chi-square, t-test, and ANOVA with the SPSS/Win 21.0 program were used to analyze the data. RESULTS: After the intervention, the experimental group showed a statistically significant increase in the total score for multicultural awareness toward North Korean defectors over the control group (t=0.85, p=.026). Scores for cognitive area (t=0.89; p=.037), ritual area (t=-0.10, p=.915), and action area (t=1.18, p=.031) increased, but the conscious area score was not statistically significant. The experimental group showed a statistically significant increase in the total score for multi-cultural efficacy for North Korean refugees (t=0.36, p=.030). Scores for cognitive area (t=0.63; p=.029), working area (t=0.05, p=.955), and emotional area (t=0.79 and p=030) increased, but the working area score was not statistically significant. CONCLUSION: It was found that the program to promote multicultural efficacy related to North Korean defectors applied in this study was effective in enhancing multicultural awareness and efficacy of nursing students.

The Status and Distinct Characteristics of Endocrine Diseases in North Korean Articles Published between 2006 and 2015

BACKGROUND: Past decades of division have led to substantial differences in medical environments between South and North Korea. However, little is known about North Korea's medical status and research field, especially regarding endocrinology. In this study, we report the characteristics of North Korea's articles regarding endocrine-related diseases. METHODS: Among the nine medical journals, articles published in Internal Medicine between 2006 and 2015 were reviewed. A total of 2,092 articles were included; among them, 96 articles were associated with endocrinology. We analyzed these articles according to the disease categories they focused on and evaluated their features. RESULTS: Articles related to diabetes mellitus accounted for 55.2% (n=53) and those to thyroid disease accounted for 28.1% (n=27). Other disease categories, including adrenal gland (n=1), pituitary gland (n=1), and osteoporosis (n=3), comprised minor portions. Regarding diabetes mellitus, more than half the articles (n=33) focused on treatment and complications. Experimental studies were conducted with old hypoglycemic drugs or natural substances for the treatment of hyperglycemia. Regarding thyroid disease, articles related to hyperthyroidism were the most common (51.9%, n=14), followed by thyroid nodule/cancer (18.5%, n=5). Unique article features were short length, no figures, and less than five references. CONCLUSION: North Korea's endocrinology articles mainly focused on diabetes mellitus and thyroid disease. Persistent studies have been carried out in North Korea with dedication despite the poor medical environment. We hope that this study will be the beginning of mutual medical exchange and collaboration between North and South Korea.

For the formation of a health community on the Korean Peninsula, inter-Korean cooperation should begin in the field of healthcare

On April 27, 2018, a historic inter-Korean summit took place. Accordingly, the hostile confrontation that lasted for the past 70 years is over, and many exchanges of human resources and material between the two Koreas are expected. In this situation, I propose that the reasons for and methods of cooperation in healthcare between North and South Korea should be among the first issues to be considered. The reasons are as follows. First, as exchanges increase, the South and the North will rapidly develop into a single health community on the Korean peninsula. Second, cooperation in the field of healthcare can play a leading role in fostering a positive attitude among South and North Koreans toward the improvement of inter-Korean relations and the possibility of future unification. Third, the two Koreas have conditions that make them ideal partners for improving healthcare quality and systems in each country. Some suggestions for specific ways to do this are presented. First, an inter-Korean healthcare agreement should be concluded. Second, specific organizations for inter-Korean cooperation should be established and operated. Third, it is necessary to form and operate a ‘control tower’ for this process in South Korea. It is expected that cooperation between the two Koreas in the field of healthcare will eventually extend to cooperation in all areas.

Discrepancies in general surgery medical terminology between South and North Korea / 한국의학교육

PURPOSE: The purpose of this study was to categorize surgery-related medical terminologies used in South and North Korea and to compare and analyze discrepancies observed in the terms. METHODS: This study collected medical terminology used in the North Korean medical book “Surgery” and compared it to medical terminology found in the medical glossary of South Korea. The order of the subtitle was described according to the Instruction to Authors. RESULTS: In total, there were 2,168 individual medical terms, of which only 1,004 words (46.3%) were identical to South Korean medical terms. There were 581 similar terms (26.8%), 265 different terms (12.2%), and 318 terms that are nonexistent in South Korea (14.7%). CONCLUSION: Less than half of the medical terms used in North Korea match those used in South Korea. It is expected that the prolongation of the current division of South and North Korea will only worsen this discrepancy. Further efforts to bridge the gap through academic exchange between South Korea and North Korea are required in preparation for an era of reunification.

What Is It to Be Mentally Healthy from the North Korean Refugees’ Perspective?: Qualitative Research on the Changes in Mental Health Awareness among the North Korean Refugees

OBJECTIVE: We investigated how mental health awareness among North Korean refugees transformed depending on temporal-spatial context changes. METHODS: In 2013, we conducted interviews with 10 refugees (eight women) who had been in South Korea for over a year and performed a qualitative analysis of the change in mental health awareness in the differences between living in North Korea, escape (a related period of forced sojourn in a third country), and settlement in South Korea. RESULTS: We classified 39 concepts into five main categories. The first two categories (while living in North Korea) were “a mindset for the system, but not for individual mental health” and “being confined in a social environment that was indifferent to mental health.” A third category appeared during escape: “focusing on survival amid continuity of intense suffering.” The final two categories appeared when settling in South Korea: “recognition of mental health amid cultural shock” and “introspection and sorting oneself out.” CONCLUSION: This qualitative study enabled a better multi-dimensional understanding of the social and cultural aspects involved in improving mental health awareness among North Korean refugees in South Korea. It is desirable to integrate mental health as a part of daily life and to expand training for North Korean settlers.

A Program to Treat Hepatitis B in North Korea: A Model of Antiviral Therapy in a Resource-Poor Setting

Despite the well-proven, safe and effective therapies for hepatitis B infection, delivery of treatment remains a significant challenge in resource-poor settings. Geopolitical and economic restrictions present additional difficulties in providing care in North Korea. However, treatment of patients with chronic hepatitis B remains a top priority for both the North Korean Ministry of Public Health and international agencies working in North Korean hepatitis healthcare facilities. Working in partnership, a path was created to institute this much-needed program. A consortium of United States and Australian humanitarian non-governmental organizations along with generous individual and corporate donors working in concert with local and national health authorities have succeeded in establishing the first hepatitis B treatment program in North Korea. The essential elements of this program include renovation of existing hepatitis hospitals, access to antiviral medications, establishment of laboratory facilities, creation of medical documentation and record-keeping, training of local health care professionals, and quarterly visits by international volunteer physicians and laboratory experts. Management and treatment decisions are made bilaterally. To date, nearly 1,500 patients have been evaluated, and over 800 have been started on long-term antiviral therapy. It is envisioned that this program will eventually be managed and funded by the Democratic People's Republic of Korea Ministry of Public Health. This program's success demonstrates a potential model for delivery of antiviral therapy for patients suffering from hepatitis B in other developing countries.

Influence of Trauma Experiences and Social Adjustment on Health-related Quality of Life in North Korean Defectors

PURPOSE: This study was conducted to identify the influence of trauma experiences and social adjustment on health-related quality of life in North Korean defectors. METHODS: The subjects were 117 North Korean defectors living in B and Y city. The data were collected from September 1 to September 20, 2014, and analyzed by the SPSS/WIN 18.0 program. RESULTS: Significant differences were found in the health-related quality of life with respect to the subjects' education, marriage status, types of dwelling, family types, duration of residence in South Korea, jobs in South Korea and in North Korea, families left in North Korea or other surrounding countries, and subjective health status. Health-related quality of life is negatively related to trauma experiences during escape from North Korea and during their life in South Korea. Health-related quality of life positively is related to social adjustment. The meaningful variables which influenced the subjects'health-related quality include social adjustment, job in South Korea, job in North Korea, current family structure, and trauma experiences in South Korea. Total explanatory power of these factors for health-related quality in North Korean Defectors is 43.0% and social adjustment is the most influential factor. CONCLUSION: Therefore, in order to enhance health-related quality of life in North Korean defectors, it is necessary for them to increase social adjustment and decrease trauma experiences. In addition, methods are needed to provide job opportunities, better education and family services for North Korean defectors.

The Trends in Research on the Health of North Korean Refugees

PURPOSE: This study aims to identify the general characteristics, subjects, and methods of research on the health of North Korean refugees through a systematic literature review. METHODS: A total of 140 studies on health were reviewed using the analytical framework developed by the researchers. RESULTS: The quantitative research comprised 90.7% of the studies, whereas the qualitative research were 7.9% of them. Approximately 81.4% of those reviewed have publication dates spanning 2006 to 2015. Only 13.6% of the studies were conducted with the approval of an institutional review board. The subjects of studies were psycho-social health (151.8%), behavioral health (28.5%), cognitive health (15.0%), physical health (12.2%), integrated health (7.8%), and spiritual health (2.8%). Within the quantitative studies reviewed, the most commonly used study design was survey research (86.0%). The two sampling methods used most often were convenience sampling (53.5%) and snowball sampling (19.4%), and the most commonly used data-collection method were questionnaires (94.6%). As for the qualitative studies, the most commonly used study design was phenomenology. CONCLUSION: The results suggested that the reviewed studies focused on physical health more than psycho-social health, and physiological measurement more than questionnaires. Ethical considerations need to be expanded.

North Korean children: nutrition and growth

North Korea suffered from severe famine in the mid-1990s; this impacted many areas, including people's transnational movement, child growth, and mortality. This review carefully examined nutritional status trends of children in North Korea using published reports from national nutrition assessment surveys. Nutritional adaptation of North Korean child refugees living in South Korea was also studied with their growth and food consumption, using published researches. The nutritional status of children in North Korea has recovered to a “low” level acute malnutrition status and a "medium" level chronic malnutrition status. Large disparities by geographic region still remain. North Korean child refugees in South Korea were significantly shorter and lighter than their age- and sex-matched South Korean counterparts (P < 0.05); however, North Korean child refugees were catching up, and weight was improving faster than height. Linear growth retarded (height for age Z-score < -1) North Korean children showed a significantly higher respiratory quotient than nonlinear growth retarded children, indicating metabolic adaptation responding to the food shortage. These changes, accompanied by abundant access to food in South Korea, have led to the elimination of significant differences in the obesity ratio between North Korean and South Korean children living in South Korea after approximately 2 years of residency. This nutritional adaptation may not be beneficial to North Korean child refugees, especially given the prediction of Barker’s theory. The lack of studies prevented a better understanding of this issue; therefore, large cohort studies, preferably with random sampling strategies, are needed to further understand this issue and to design appropriate interventions.

Health Literacy and Its Related Factors in North Korean Refugees

BACKGROUND: In September 2016, the number of North Korean refugees living in South Korea was 29,688. They have been struggling with health problems due to their poor health status and the differences in medical system and terminology between South and North Korea. We aimed to investigate the level of health literacy and its related factors in North Korean refugees. METHODS: This study was conducted with 142 patients who visited North Korean refugees' counseling center at Seoul Medical Center and National Central Medical Center and 100 South Korean patients who visited outpatient clinics or Health Promotion Center of Seoul Medical Center. General and health-related characteristics were surveyed through a questionnaire and health literacy was measured by using ‘Korean Adult Health Literacy Scale’. RESULTS: The average age of North Korean refugees was 48.92±11.49 years old. Almost 95% reported that their monthly income was less than 2 million KRW. The survey showed that North Korean refugees obtain health information mainly through TV, radio, and acquaintances and more than half (54.9%) said their health was bad or very bad. The mean score of North Korean refugees' health literacy was much lower than that of South Koreans (12.42±7.58 vs. 25.3±5.7, P<0.001). This discrepancy was maintained after adjusting related factors such as age, sex, and socioeconomic status with stratified analysis. CONCLUSIONS: It suggest the urgent need for policies which support for futher researches and development of education system, which may lead to the improvememt of the health literacy of North Korean regugees.

Changes in body weight and food security of adult North Korean refugees living in South Korea

BACKGROUND/OBJECTIVES: Relocation to new environments can have a negative impact on health by altering body weight and dietary patterns. This study attempted to elucidate changes in body weight, food security, and their current food and nutrient consumption in adult North Korean refugees (NKR) living in South Korea (SK). SUBJECTS/METHODS: This study analyzed data on 149 adult NKR from a North Korean refugee health in SK cohort at four time points (leaving North Korea, entering SK, first examination, and second examination). Body weight was self-reported at the two earlier time points and directly measured at the two later time points. Food security, diet-related behaviors (dietary habits and food consumption), and sociodemographic information were obtained using a self-administered questionnaire. Nutrient intake information was obtained by one-day 24-hour recall. Statistical analyses were performed with SPSS ver 23.0. RESULTS: Body weight increased during relocation by an average of 4 kg, although diversified patterns were observed during the settlement period in SK. Approximately 39.6% of subjects maintained their body weight between the first and second examinations, whereas 38.6% gained and 22.1% lost at least 3% of their body weight at the first examination by the second examination. Food security status improved from 12.1% food secure proportion to 61.7%. NKR showed generally good food and nutrient consumption (index of nutrient quality: 0.77–1.93). The body weight loss group showed the most irregular meal consumption pattern (P < 0.05), and eating-out was infrequent in all three groups. Consumption frequencies of food groups did not differ by group, except in the fish group (P = 0.036). CONCLUSION: This study observed considerable body weight adjustment during the settlement period in SK after initial weight gain, whereas food security consistently improved. More detailed understanding of this process is needed to assist healthy settlement for NKR in SK.

Health Behavior and Factors Associated with Depression in North Korean Adolescent Defectors in South Korea: The Korea Youth Risk Behavior Web-Based Survey, 2011–2014 / 가정의학회지

BACKGROUND: The number of North Korean adolescent defectors entering South Korea has been increasing. The health behavior, including mental health-related behavior, and factors associated with depression in North Korean adolescent defectors residing in South Korea were investigated. METHODS: Data obtained from the Korea Youth Risk Behavior Web-Based Survey (2011–2014) dataset were utilized. In total, 206 North Korean adolescent defectors were selected, and for the control group, 618 matched South Korean adolescents were selected. Frequency analysis was used to determine the place of birth and nationality of the parents, chi-square tests were used to compare the general characteristics of the North and South Korean subjects, and multivariate logistic regressions were conducted to compare the health behavior of the two sets of subjects. To determine the factors associated with depression in the North Korean subjects, a logistic regression was performed. RESULTS: The North Korean adolescents reported higher current smoking (adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.48 to 4.35), current drinking (aOR, 1.85; 95% CI, 1.15 to 2.99), and drug use rates (aOR, 10.99; 95% CI, 4.04 to 29.88) than did the South Korean adolescents. The factors associated with depression in the North Korean adolescents were current smoking (aOR, 6.99; 95% CI, 1.62 to 30.06), lifetime drinking experience (aOR, 5.32; 95% CI, 1.51 to 18.75), and perceived stress (aOR, 4.74; 95% CI, 1.74 to 12.90). CONCLUSION: There were differences in health behavior between the North and South Korean adolescents. A specialized approach for North Korean adolescent defectors is required to promote proper health behavior and adaptation to South Korean society.

Effects of Parenting Stress in North Korean Refugee Fathers on Their Parenting Behavior

PURPOSE: The purpose of this study was to identify effects of parenting stress in North Korean refugee fathers on their parenting behavior. METHODS: A descriptive study design was used. Data were collected during 2014 and 2015 in a settlement support center for North Korean refugees and 99 North Korean refugee fathers participated. Data were analyzed using SPSS 21.0. RESULTS: Warmth·encouragement parenting behavior received the highest score. The score for parenting stress was 81.98 out of 180, and 32.3% of participants were found to need professional help (≥PSI 90). There were significant negative correlations between warmth·encouragement parenting behavior and parenting stress. There were also significant positive correlations between rejection·neglect parenting behavior and parenting stress. Predictors of warmth·encouragement behavior were parent-child dysfunctional interaction which explained 10.1% of the variance. Predictors of rejection·neglect behavior were parent-child dysfunctional interaction, number of children and wife's education level which explained 33.4% of the variance. CONCLUSION: Findings show that North Korean refugee fathers' parenting stress significantly influenced warmth·encouragement and rejection·neglect parenting behavior indicating a need to identify ways to decrease parenting stress. Parenting education can guide North Korean refugee fathers to strengthen parent-child positive interactions and therefore promote their children's growth and development.

North Korean refugee doctors' preliminary examination scores / 한국의학교육

PURPOSE: Although there have been studies emphasizing the re-education of North Korean (NK) doctors for post-unification of the Korean Peninsula, study on the content and scope of such re-education has yet to be conducted. Researchers intended to set the content and scope of re-education by a comparative analysis for the scores of the preliminary examination, which is comparable to the Korean Medical Licensing Examination (KMLE). METHODS: The scores of the first and second preliminary exams were analyzed by subject using the Wilcoxon signed rank test. The passing status of the group of NK doctors for KMLE in recent 3 years were investigated. The multiple-choice-question (MCQ) items of which difficulty indexes of NK doctors were lower than those of South Korean (SK) medical students by two times of the standard deviation of the scores of SK medical students were selected to investigate the relevant reasons. RESULTS: The average scores of nearly all subjects were improved in the second exam compared with the first exam. The passing rate of the group of NK doctors was 75%. The number of MCQ items of which difficulty indexes of NK doctors were lower than those of SK medical students was 51 (6.38%). NK doctors' lack of understandings for Diagnostic Techniques and Procedures, Therapeutics, Prenatal Care, and Managed Care Programs was suggested as the possible reason CONCLUSION: The education of integrated courses focusing on Diagnostic Techniques and Procedures and Therapeutics, and apprenticeship-style training for clinical practice of core subjects are needed. Special lectures on the Preventive Medicine are likely to be required also.

A Study of Predictive Factors Affecting Health: Promoting Behaviors of North Korean Adolescent Refugees / 예방의학회지

OBJECTIVES: The present study aimed to analyze the factors that could affect the health-promoting behaviors of North Korean adolescent refugees residing in South Korea. METHODS: Questions about their sociodemographic variables, subjective health status, healthy living habits, and health-promoting behaviors were asked. RESULTS: Statistically significant differences were found in religion (t=2.30, p<0.05), having family members in South Korea (t=2.02, p<0.05), and subjective health status (t=4.96, p<0.01). Scores on health-responsible behaviors were higher with higher age (t=2.90, p<0.01) and for subjects without family or friends (t=2.43, p<0.05). Higher physical-activity behaviors were observed in males (t=3.32, p<0.01), in those with better subjective health status (t=3.46, p<0.05) and lower body mas index (t=3.48, p<0.05), and in smokers (t=3.17, p<0.01). Nutritional behaviors were higher in those who followed a religion (t=2.17, p<0.05). Spiritual growth behaviors were higher in those who followed a religion (t=4.21, p<0.001), had no family in South Korea (t=2.04, p<0.05), and had higher subjective health status (t=5.74, p<0.01). Scores on interpersonal relationships and stress-management behaviors were higher for those with higher subjective health status. A multiple regression analysis showed greater effects on health-promoting behaviors when subjective health status was better. Older people and non-smokers exhibited more health-responsible behaviors, while more physical-activity behaviors and spiritual growth activities were observed when subjective health status was better. Interpersonal relationship behaviors had positive effects on those with good subjective heath status and on non-smokers. CONCLUSIONS: Based on the results of the current study, an alternative was suggested for promoting health in North Korean adolescent refugees.

A new strategy for tuberculosis control in North Korea / 한국역학회지

Tuberculosis is one of the most prevalent diseases in North Korea. Despite some positive accomplishments by current aid projects, it is still necessary to investigate the existing aid system. The following are necessary for improvement: sustaining a high degree of expertise, cooperation among various related parties including the international community, mediation to induce this cooperation, a more active role of the South Korean government, and encouragement of North Korea to more actively participate. Achieving these will help solve the issues of current tuberculosis aid projects in North Korea and lead to more successful outcomes.