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.

Acolhimento institucional é creche? a reintegração familiarl / Is the institutional care nursery? the family reunification / ¿Acogida institucional es guardería? la reintegración familiar

O acolhimento institucional e reintegração familiar são processos relacionais que envolvem vários sistemas: família, instituição de acolhimento e justiça. Neste texto, objetivou-se conhecer a compreensão que uma família com filhos em acolhimento tem sobre essa medida de proteção e sobre o processo de reinserção familiar. Para isso, realizaram-se pesquisa documental e entrevista com uma mãe de crianças institucionalizadas. Os resultados foram analisados com base na hermenêutica de profundidade. Obtiveram-se dois núcleos de compreensão: história familiar e os significados do acolhimento e da reintegração familiar. A história familiar apresenta instabilidade dos acontecimentos, descontinuidade relacional e a permanente luta pela sobrevivência. Os significados do acolhimento para a família relacionam-se à proteção dos filhos, e a reintegração familiar apresenta posições paradoxais de querer ou não o filho de volta.

The institutional care and family reunification are relational processes which involve multiple systems - family, the institution and justice. In this text, this paper aimed to understand the meaning about institutionalization and family reunification for a family with children in foster care. The method was documentary research and interview with a family. The results were analyzed from the Hermeneutics of Depth. This research had two cores of understanding: family history and meanings of institutionalization and family reunification. Family history exhibits instability of events, relational discontinuity and ongoing fight for survival. The meanings of the host family are related to the protection of children and family reunification presents paradoxical position of wanting or not the child back.

La acogida institucional y la reintegración familiar son procesos relacionales que involucran múltiples sistemas - familia, institución de acogida y justicia. En este texto, el objetivo era conocer la comprensión que una familia con hijos acogidos tiene sobre esa medida de protección y sobre el proceso de reinserción familiar. Para eso se realizarán investigación documental y entrevistas con una madre de niños institucionalizados. Los resultados fueron analizados a partir de la hermenéutica de la profundidad. Se obtuvieron dos núcleos de comprensión: historia familiar y los significados de la acogida y la reinserción familiar. La historia familiar presenta inestabilidad de los acontecimientos, discontinuidad relacional y permanente lucha por la supervivencia. Los significados de la acogida para la familia están relacionados con la protección de los hijos, y la reintegración familiar presenta posiciones paradójicas de querer o no al hijo de vuelta.

La predicción afectiva positiva como factor de protección socio-emocional en madres transnacionales antes y después de la reagrupación familiar: relación con la satisfacción con la vida, regulación emocional, soledad social, resiliencia y estrés / Positive affective prediction as a factor of social emotional protection in transnational mothers before and after family reunification: relationship with life satisfaction, emotional regulation, social loneliness, resilience and stress

La predicción afectiva es un proceso de sobrestimación emocional previo a un acontecimiento. Suele asociarse a altas expectativas y a un coste socioemocional posterior. Para estudiar las diferencias entre las predicciones afectivas antes y después de la reagrupación familiar transnacional, se analizan a 188 madres inmigrantes residentes en España, bien expectantes por reagrupar, bien reagrupadas con sus hijos. Se hipotetiza y confirma la existencia de diferencias estadísticamente significativas entre las mujeres en situación antes y después en relación a satisfacción con la vida, control emocional, resiliencia, estrés y soledad social. Además, se, resalta la función positiva del pronóstico afectivo en el ajuste socio cognitivo de las madres transnacionales. Previamente al evento, éste media entre la satisfacción y la soledad social, y después de la reagrupación, tiene una función mediadora entre la satisfacción vital y el descontrol emocional asociado al encuentro lo que expresa su papel protector en la conciliación familiar.

Affective forecasting is an emotional process of overestimation of the future. Previous studies indicate that if these expectations are excessive and do not coincide with reality they can lead to a high socio emotional cost after the event. In order to analyze the differences in affective predictions before and after transnational reunification 188 immigrant mothers resident in Spain were divided in two groups according to whether or not they had regrouped with their children. Both groups were homogeneous in socio-demographics (age, number of children, education level, employment status, and reasons for migrating). The results confirm the existence of significant differences between emotional experience, before and after reunification. It was found that affective forecasting played a positive role before and after the event for the variables affecting socio-cognitive regulation in both groups (well-being, emotional regulation, resilience and stress), but in different manner during the process of transnational family reunification.

Leading Study for the Restoration of Pediatric Immunization Systems in North Korea following Reunification of Korean Peninsula

BACKGROUND: 8,000 children in North Korea died before they reached the 1 year after births in 2013. The high mortality rate of children under five years of age is mainly caused by infectious diseases and malnutrition. The need for national pediatric immunization and supply of vaccines will be vital when the abrupt reunification occurs. OBJECTIVE: The purpose of this study is to scrutinize the pediatric immunization coverage of North Korea. Additionally it is to estimate the amount and the costs needed to vaccinate. METHODS: The target population is the children of North Korea. The method is based on a pre-survey and an interview of North Korea defectors. The target interviewees searched for are as follows; doctors, teachers, and others. The interview includes questions on mortality rates and immunization coverage. The analysis is largely based on the statements of the health care providers within the selected group. RESULTS: The interviewees are 8; 7 female and 1 male. The birth years range from 1956 to 1982. 3 out of 8 are former health care providers; a doctor, a pharmacist, and a nurse. The morbidity rate of infectious diseases exceeds the data from WHO. The immunization coverage is nearly 0% after 1980s. In order to ensure the welfare of North Korean children, at least 8,234,000 vaccine doses, requiring over 105 million U.S. dollars, are needed. CONCLUSION: The morbidity rate of infectious disease in North Korea is conspicuous. The preparation for supply and expenditure of vaccines is vital.

O processo de reinserção familiar sob a ótica das equipes técnicas das instituições de acolhimento / Family reinsertion processes as seen from the standpoint of foster care technical teams / El procedimiento de reintegración familiar según experiencias del personal de instituciones de amparo

Profissionais das instituições de acolhimento vêm encontrando sérias dificuldades para promover a reinserção familiar das crianças e adolescentes, contribuindo para um prolongado tempo de institucionalização, que pode trazer inúmeras consequências negativas para o desenvolvimento saudável destas. Este estudo investigou a visão dos integrantes das equipes técnicas de seis instituições de acolhimento de um município do Espírito Santo acerca do processo de reinserção familiar de crianças e adolescentes. Foram realizados dois grupos focais, com a participação de 12 técnicos. Também foi utilizada a técnica da inserção ecológica e os dados foram registrados em Diário de Campo. Os resultados indicam credibilidade e envolvimento dos técnicos nos processos de reinserção familiar, apesar das dificuldades por eles destacadas: a não adesão das famílias aos programas de apoio familiar, a incompreensão de alguns componentes da rede sobre a família extensa, a falta de recursos financeiros das famílias e a valorização da instituição, por parte dos pais, como local ideal para seus filhos permanecerem. Superar a visão de família nuclear, promover articulação com a rede sócio assistencial e jurídica e aplicar o princípio da brevidade são os grandes desafios que as equipes técnicas devem vencer para promover com mais eficiência a reinserção familiar.

Foster care professionals have encountered difficulties in their attempt to promote the reinsertion of children and adolescents with their families within their own community. This fact alone is what forces those young persons to remain in foster care institutions for a longer period of time than is thought advisable. This, in turn, triggers off a great number of negative impacts on the development of those youths as human beings. As regards the process of family reinsertion, this paper investigated the technical teams of six foster care institutions located in Espírito Santo, Brazil. Two focus groups were conducted, with the participation of 12 technicians. The ecological insertion technique was also used, and the data were all recorded in a Field Journal. The results indicate credibility and involvement of the technicians in the reinsertion process despite all these difficulties: the non-adherence of the families to the family support program; the lack of understanding of some of the network's components as regards extended families; the family's insufficiency of financial resources; and the overvaluation of the institution as the ideal environment where their children can stay. Questioning the notion that all families are nuclear, encouraging improvements in the interaction between foster care institutions and the support network, and applying the principle of brevity are the major challenges that technical teams have to face in order to efficiently promote family reinsertion.

Los profesionales de instituciones de amparo están encontrando sérias dificultades al fomentar la reintegración familiar de niños y adolescentes, lo cual ocasiona una permanencia más prolongada en estas instituciones - situación que provoca numerosas consecuencias negativas para el sano desarrollo de los mismos. Este estudio tuvo como objetivo conocer la opinión de los integrantes del personal técnico de seis instituciones de amparo de un municipio de Espírito Santo, Brasil, sobre la reintegración familiar. Fueron realizados dos grupos focales, con la participación de 12 técnicos. Fue utilizada también la técnica de inserción ecológica, y los datos fueron registrados en Diario de Campo. Los resultados demuestran la credibilidad y comprometimiento por parte del personal técnico, a pesar de las dificultades por ellos registradas: la falta de apoyo de las familias en relación a los programas de ayuda familiar, la intransigencia de algunos integrantes de la red respecto a la familia extensa, la falta de recursos financieros de las familias y la valorización de la institución, por parte de los padres de familia, como establecimiento ideal para la permanencia de sus hijos. Superar la opinión del familia nuclear, fomentar el acoplamiento con la red socio-asistencial y jurídica y poner en práctica el principio de la brevedad son los grandes desafíos que el personal técnico debe vencer para impulsar con más eficiencia la reintegración familiar.

Plan on establishment of post-unification North Korean medical safety net

Establishing social security networks for the reunification of the Koreas is important to minimize social disturbances. Above all, it is highly critical to establish a medical safety net. The non-political and humanitarian aspects of medical services may be used as a valuable tool to initiate peaceful exchanges between the two Koreas amid geopolitical tensions. It is necessary to determine principles and set up strategies in order to build medical safety net in the course of reunification. A staged approach is required. In the first phase, we need to establish a system to ensure expedited basic medical services while South Korea's medical insurance, public medical care, and emergency medical service systems are replicated in the second phase. The North Korean system then needs to be developed into a more robust medical safety net in the third phase. In order to engage in this approach successfully, it is necessary to close gaps and promote trades between the two Koreas, conduct consistent research and monitoring, and secure a professional personnel pool. Along with such efforts, it will also be necessary to coordinate other political, social, economic, and cultural policies and processes of establishing other social security nets. The successfully established medical safety net will play an important role in maximizing the benefits of reunification.

Institucionalização e reinserção familiar de crianças e adolescentes / Institutionalization and family reunification process of children and adolescents

Este artigo traz reflexões sobre a reinserção familiar de crianças e adolescentes institucionalizados, apresentando estratégias e procedimentos necessários à preparação do seu retorno à convivência em família. Discute aspectos históricos e teóricos que caracterizam a família e o abrigo como contextos primários e abrangentes de desenvolvimento humano, especialmente nas circunstâncias de vida em que a criança e o adolescente se encontram em situação de vulnerabilidade social e existe grave ameaça à sua integridade física, psicológica e moral. Apresenta resultados de estudos e pesquisas que procuram revelar as condições em que a criança e adolescente vivenciam transições importantes como o seu afastamento do núcleo familiar e posterior acolhimento por uma instituição de abrigo. Assim como discute questões trazidas por diversos autores acerca dos limites e possibilidade do processo de desligamento de um programa de acolhimento institucional e o caminho de volta para casa sob a ótica dos sujeitos envolvidos. Destaca, sobretudo, a importância de medidas sociais adotadas pela instituição para preservar e fortalecer os vínculos familiares, promovendo um retorno rápido e seguro ao convívio com os pais e demais familiares. Situa a discussão do direito à convivência familiar no campo da política de atenção às necessidades básicas e especiais da criança e do adolescente em situação de vulnerabilidade social, assim como o valor dessa experiência para o desenvolvimento humano.

This article contains reflections on family reintegration of institutionalized children and adolescents, presenting strategies and procedures needed to prepare his return to living with the family. Discusses historical and theoretical perspectives that characterize the family and the shelter as primary contexts and comprehensive human development, especially in the circumstances of life in which children and adolescents are in a situation of social vulnerability and there is serious threat to their physical, psychological and moral. Presents results of studies and research aimed at revealing the conditions in which children and adolescents experience major transitions such as being away from the family nucleus and subsequent reception by a shelter. As discussed matters brought by several authors about the limits and possibilities of the process of shutting down a program of residential care and the way back home from the perspective of those involved. It highlights in particular the importance os social measures adopted by the institution to preserve and strengthen family bonds, promoting safe and quick return to living with parents and other family members. It situates the discussion of the right to family policy in the field of attention to basic needs and special conditions of children and adolescents in situations of social vulnerability, as well as the value of this experience for human development.

Processo de reinserção familiar: estudo de casos de adolescentes que viveram em instituição de abrigo / Family reunification process: case studies of adolescents who lived in shelters

O objetivo desse estudo foi compreender longitudinalmente o processo de reinserção familiar de três adolescentes que moravam em abrigos. Visitas domiciliares e Entrevistas de Reinserção foram utilizadas com os participantes e um membro da família, durante um período que variou de seis a 18 meses. Os resultados indicaram que as famílias se encontravam em situação de vulnerabilidade; não houve uma preparação dos jovens e familiares para o retorno; e não foi disponibilizado apoio após o desligamento da instituição. Dois dos adolescentes demonstraram satisfação com a reinserção após alguns meses de desligamento, embora a situação de pobreza e baixo desempenho escolar fossem percebidos como problemas pelos participantes. No terceiro caso, problemas na condução da reinserção fizeram com que a adolescente fosse reabrigada. Discute-se a necessidade de políticas públicas e de programas desenvolvidos por profissionais capacitados, em parceria com os abrigos, que visem à promoção da convivência familiar.

The goal of this study was to longitudinally understand the family reunification process of three adolescents who lived in shelters. Home visits and Reunification Interview were used with the adolescents and a family member, during a time that ranged from six to 18 months. The results highlighted that such families socially vulnerable; there was no family and adolescents preparation for the reinsertion; and there was no support after such process of detachment from the institution. Two adolescents were satisfied with reunification after some months, although the poor conditions and low academic achievement had been perceived as a problem by the participants. On the third case, there were problems to handle reunification and the adolescent returned to the shelter. The need of public policies and programs, develop by able professionals, engaging with the shelters, are discussed, aiming to promotion family reunification.

Review of Adaptation and Mental Health of Refugees and Perspectives and Counterplots in Korean Reunification Process / 신경정신의학

It is anticipated that mass refugees from North Korea can happen in the process of Korean reunification. In this paper, the author reviewed the adaptational and mental health problems of refugees, especially Indochinese refugees, and discussed several topics which could be problems of Korea. Great adaptational differences between social classes in Vietnamese refugees were noted, therefore it is suggested that different resocialization program should be prepared for each social class of North Korea. General problems of refugees are found to be broken family problems, conflict in family due to role conversion, attitude of mass media in dealing with refugees, problems of education for living and difficulties with establishing the effective helping system. Therefore, in the resocialization program, the above problems besides economic support should be considered in Korea. Also, refugees were reported to have severe mental problems especially depression, anxiety, posttraumatic stress disorder, dissociation, etc. And refugees usually are afraid of expressing their psychiatric problems and meeting with psychiatrists. South Korean psychiatrists should know about the characteristic of North Korean people and develop adequate approaching and interviewing techniques and treatment plan. As the South and North Korea have had very different systems for 50 years, it should be very difficult and important to make the two people adapt and harmonize in new unified society.