An exploratory study on development policy and the status of oral health care in the North Korea during the Kim Jong-Un era / 대한구강보건학회지

OBJECTIVES: Studies on oral health care in North Korea are being pursued in South Korea. However, the covertness of North Korea offers substantial resistance to the access of information from the country, including in the field of oral health care. In this study, we explored North Korea's oral health care policy and its status in the Kim Jong-Un Era.METHODS: We used existing information from Internet searches and also interviewed three health care professionals who had recently contact with North Korea.RESULTS: At present, there are four development policies of oral health care in North Korea: expansion of dental institutions and resource support, strengthening the prevention and treatment of dental diseases, improvement of dental prosthetics, and increasing the responsibility and role of the dental workforce. In addition, there has been an increasing interest in children's oral health with the development of a few programs.CONCLUSIONS: In order to improve overall oral health care, cooperation is required from North Korea in accessing relevant information in the field of children's oral health, dental prosthetics, and dental materials. For this to occur, there should be a preliminary trust building process between North Korea and South Korea as well as access to information from reliable sources.

Efforts to prepare inter-Korea medical consolidation: compilation of a medical dictionary for all of Korea

It is known that there are wide disparities in the medical terms and language that medical professionals currently use in South and North Korea. How much chaos can be expected when people will be able to come and go freely unless there is an effort to lessen these gaps? To minimize medical mess in advance and to provide a better environment to strengthen collaborative exchanges between South and North Korea, which should be independent of political beliefs and dynamics, as part of the efforts for inter-Korea medical consolidation, I would like to underscore the need to compile an integrative medical dictionary. For the compilation of such a dictionary, the following process and preparations are suggested. First, there should be a database of medical terminology from North Korea through a search of various types of literature in North Korea, including dictionaries, journals, and textbooks. Second, entry words for an integrative dictionary based on English terms should be included. Third, specialists in medical terminology from the northern side should participate in the editing process and hold discussions with their southern counterparts. Fourth, after the full discussion and consensus has taken place, print and web versions of the dictionary can be published. Furthermore, a dissemination plan should be established to be used widely with both sides. The above strategy should also be supported by not only the medical society in South Korea but also the Korean government.

Dietary behaviors and nutritional status according to the bone mineral density status among adult female North Korean refugees in South Korea / 한국영양학회지

PURPOSE: North Koreans could be at higher risk for their bone health because of previous periods of severe famine and the continuing low availability of food. This study determined the bone mineral density (BMD) status and its relationship with dietary behaviors and nutrient intake of North Korean refugees (NKR) in South Korea (SK). METHODS: This cross-sectional study analyzed 110 female NKR from a NORNS cohort of a non-probability sample of adult NKR in Seoul. BMD examined by DEXA was used to divide participants into the normal group (NG) and the non-normal group (NNG) according to the WHO guideline. A self-administered questionnaire included questions on age, the socioeconomic situation in North Korea (NK) and SK, the food security in NK and SK, and the health behaviors, dietary behaviors, and food frequency questionnaire administered in SK. A one-day 24-hr recall was conducted and the results were analyzed by using CanPro. SPSS was used to analyze whether BMD and related dietary behaviors and nutrient intakes differed according to the groups. RESULTS: NG (62.7%) was significantly younger and had a lower abdominal obesity score than NNG (p < 0.001). While 14.5% of NG reported experiencing menopause, all of NNG reported experiencing menopause. The NG more frequently consumed the dairy group of foods (9.6 times a week) than did the NNG (4.8 times a week) after the statistics were adjusted for age (p < 0.007). The NG consumed significantly more animal protein and animal calcium than did the NNG (p = 0.01, p = 0.009, respectively). Calcium intake was low with 49.3% of NG, and 78.0% of the NNG reported consuming calcium lower than the estimated average requirement. Only calcium showed an index of nutrient quality lower than one in both groups. CONCLUSION: These results showed that NKR women and possibly all North Korean women are at high risk for bone health and they consumed low levels of bone-related nutrients, and this should be considered for the nutrition policy for NKR and North Korea.

Underestimated Burden: Non-Communicable Diseases in North Korea

There remains a misperception that non-communicable diseases (NCDs) are predominantly an issue for developed countries and are not major public health problems in low-income countries. North Korea is also often considered as a country with a disease structure that is typical of a low-income country. Infectious diseases and nutritional problems, including tuberculosis and pneumonia, are still major sources of medical discussion. The authors challenge this misperception by reviewing empirical data on epidemiologic and demographic transitions of North Korea and show that the current NCD burden is the main public health issue in North Korea. In result, it can be said that epidemiologic transition and demographic transition of North Korea preceded prior to economic hardship. It is necessary for the international community, including South Korea, to advance in a new direction of medical support for North Korea.

Malaria Incidence of the Regions Adjacent to the Demilitarized Zone in the Democratic People's Republic of Korea, 2004–2016

BACKGROUND: Vivax malaria reemerged in the Korean peninsula in 1990s beginning from the western border area and spread across both Koreas rapidly with its peak incidences reported on the early 2000s. There have been few reports on the malaria incidence in the Democratic People's Republic of Korea (North Korea) that provides detailed epidemiological features. The purpose of this study was to describe the time trends and spatial distribution of malaria in North Korea with comparison to those in South Korean regions across the border. METHODS: The incidence of malaria in each province of North Korea from 2004 to 2016 was estimated based on data from domestic and international health authorities. Consistency of the data was evaluated by calculating the ratio of malaria cases in each province to the total cases each year. We also compared the changes in malaria incidence over time in South and North Korea adjacent to the demilitarized zone. RESULTS: In North Korea, the incidence of malaria in the three provinces adjacent to the demilitarized zone was the highest (52.1−315.3 per 100,000), followed by Pyeonganbuk-do (14.7−113.5 per 100,000), where railways and road networks were connected to northern China. The incidence of malaria in each province of North Korea reported after 2011 was more consistent than when compared with previous annual data, and there was also a positive correlation between changes in incidence over time when compared with malaria incidence in South Korea (r = 0.855, r = 0.596). CONCLUSION: The malaria report of North Korea was relatively consistent in its spatiotemporal tendency since 2011, suggesting improvement of the quality of the surveillance data. The strong correlation between North and South Korean malaria incidence at regional level suggests that collaboration between both sides are essential for the successful elimination of malaria in the Korean peninsula.

Infections of Soil-Transmitted Helminth in Refugees from North Korea

Soil-transmitted helminthiases (STH) are now no longer public health problems in the Republic of Korea (South Korea), but their status are unavailable in the residents of North Korea (NK) despite the expectation of large scale traffic and future reunification of the Korean Peninsula. A total of 20 female refugees from NK who had been admitted to the Division of Gastroenterology, Dankook University Hospital, were subjected in this study. Among them, 15 refugees were examined by the colonoscopy and 10 ones were examined with the stool examination (formalin-ether sedimentation). Both diagnostic methods were commonly adopted in 5 patients. Eggs of Trichuris trichiura were detected in 7 out of 10 refugees in the stool examination. In the colonoscopy, T. trichiura worms were found in 6 (40.0%) out of 15 refugees. Total 9 (45.0%) peoples were confirmed to be infected with human whipworms. Additionally, 1 case of clonorchiasis was diagnosed in the stool examination and a worm of Ascaris lumbricoides was discovered from a trichuriasis case. These findings suggested that STH is highly prevalent in NO, in which living conditions are not so good in the aspect of general hygiene and medical care.

Bibliographical Characteristics of North Korean Medical Journals and Articles

The aim of our work was to analyze the bibliographical characteristics of 9 North Korean medical journals and articles. All journals show only ten pieces of information, such as publication dates and table of contents, and do not provide submission guidelines and journal policy. Most of the journals were published four times a year. Editorials often share government policy. Research articles are very short and compressed. The journals often publish articles on oriental medicine and medical information useful to the public. In conclusion, the journals were published in their own unique style and format, which are far from the global standard.

Structural Equation Model for Psychosocial Adjustment in North Korean Adolescent Refugees

PURPOSE: This study aimed to identify variables influencing the psychosocial adjustment of North Korean adolescent refugees in order to establish a structural equation model and design an intervention strategy to improve psychosocial adjustment. METHODS: The subjects included 290 North Korean adolescent refugees aged 16~24 years who were enrolled in alternative schools or regional adaptation centers. They were surveyed using a structured questionnaire. RESULTS: The goodness of fit measures of the model were as follows: x²=131.20 (p < .001), GFI=.93, CFI=.91, TLI=.86, RMSEA=.08, and SRMR=.07. The results estimated from the structural equation model indicated a good fit of data to the hypothesized model, which proposed that stress and emotional intelligence are associated with psychosocial adjustment. The major variables influencing psychosocial adjustment were stress, emotional intelligence, which was a significant direct effect, whereas attitude of parenting showed an indirect effect on psychosocial adjustment through emotional intelligence. These variables account for 50.0% of psychosocial adjustment. CONCLUSION: It is necessary to develop a program and intervention plan that can enhance emotional intelligence and thereby relieve the stress of North Korean adolescent refugees. The program should also include parenting education so that parents have positive attitude of parenting.

Characteristics of Drug Resistant Tuberculosis in Sanatoria of North Korea

Although several reports about drug-resistant tuberculosis (TB) in North Korea have been published, a nationwide surveillance on this disease remains to be performed. This study aims to analyze the drug resistance patterns of Mycobacterium tuberculosis among the patients in the sanatoria of North Korea, especially during the period when second-line drugs (SLDs) had not yet been officially supplied to this country. The Eugene Bell Foundation (EBF) transferred 947 sputum specimens obtained from 667 patients from 2007 to 2009 to the Clinical Research Center, Masan National Tuberculosis Hospital (MNTH), South Korea. Four hundred ninety-two patients were culture positive for TB (73.8%). Drug susceptibility test (DST) was performed for the bacilli isolated from 489 patients. Over 3 quarters of the cases (76.9%) were multidrug-resistant (MDR)-TB. Additionally, 2 patients had extremely drug-resistant (XDR)-TB. Very high resistance to first-line drugs and low resistance to fluoroquinolones (FQs) and injectable drugs (IDs) except for streptomycin (S) were detected. A small but significant regional variation in resistance pattern was observed. Big city regions had higher rate of MDR-TB, higher resistance to FQs and IDs than relatively isolated regions. In conclusion, significant number of drug-resistant TB was detected in North Korean sanatoria, and small but significant regional variations in resistance pattern were noticeable. However, the data in this study do not represent the nationwide drug resistance pattern in North Korea. Further large-scale evaluations are necessary to estimate the resistance pattern of TB in North Korea.

The Formation of the Military Medical System of the Korean People's Army and the Military Medical Officer / 의사학

The military medical system of the Korean People's Army (KPA) first appeared in August 1946 when a central military hospita was established at the headquarters. Inside the KPA, the military medical and veteran services were first established in February 1948. The military medical officers of the KPA were those who were initially engaged in North Korea's health care sector. Most of the early military medical officers were those who had been trained in the Japanese medical system before liberation and were surgeons. After the establishment of the government in September 1948, Lee Dongwha rapidly introduced the medical system of the Soviet army into the KPA. The KPA military medical system was a mix of Soviet, Japanese and Chinese military medical systems. The medical section of the KPA was similar to that of the Japanese army, and the medical section of the lower army was similar to that of the Soviet army. The stretcher platoon of the KPA were similar to those of the Japanese and Chinese armies. The KPA mainly used Japanese medical equipment at the beginning, and after the establishment of the North Korean regime in September 1948, they were gradually replaced with Soviet products. The military medical office of the KPA were equipped with treatment rooms, laboratories, hospitals, pharmacy, and inpatient rooms. The military medical office purchased medical journals and specimens for medical research and set up a separate research fund. In addition, the military medical office was equipped with a laboratory for medical experiments and raised laboratory animals. The KPA military medical system was specialized in the fields of infectious disease prevention and preventive medicine. At the time, infectious disease in North Korea was mainly caused by bacteria and viruses in unsanitary living environments. The KPA set up a special anti-infectious disease department in consideration of the soldiers living in the collective facilities. The second characteristic of the KPA military medical system is preventive medicine. Since early 1946, North Korea has been interested in preventive medicine and has established various medical facilities and personnel. In line with this history of preventive medicine, the preventive department was installed in the KPA military medical system.

Prevalence of Anaplasma, Bartonella and Borrelia Species in Haemaphysalis longicornis collected from goats in North Korea

North Korea is located on the northern part of the Korean Peninsula in East Asia. While tick-borne pathogens of medical and veterinary importance have been reported from China and South Korea, they have not been reported from North Korea. To screen for zoonotic tick-borne pathogens in North Korea, ticks were collected from domestic goats. A total of 292 (27 nymph, 26 male, 239 female) Haemaphysalis (H.) longicornis were collected and assayed individually for selected tick-borne pathogens. A total of 77 (26.4%) were positive for Anaplasma bovis, followed by Bartonella (B.) grahamii (15, 5.1%), Anaplasma phagocytophilum (12, 4.1%), Bartonella henselae (10, 3.4%), and Borrelia spp. (3, 1.0%) based on 16S ribosomal RNA and ITS species-specific nested polymerase chain reaction. Using the groEL-based nested PCR, a total of 6 and 1 H. longicornis were positive for B. grahamii and B. henselae, respectively. All products were sequenced and demonstrated 100% identity and homology with previously reported sequences from other countries in GenBank. This is the first report of the detection of tick-borne pathogens in the North Korea and suggests that farm animals may act as reservoirs for zoonotic tick-borne pathogens.

Identifying Research Direction for Mental Health of North Korean Refugees Using Delphi Technique / 신경정신의학

OBJECTIVES: Refugees from North Korea are at risk of a range of mental health problems, posing urgent problems to their care. A review of research on mental health prevalence and services can indicate directions for further study. METHODS: The authors administered a Delphi survey to 16 professionals who are working for North Korean refugees, including professors and field workers. The collected data was analyzed by descriptive statistics including mean and standard deviation and verified with content validity ratio. RESULTS: The results are as follows: 1) The most serious problem in the research area is the importance of quantitative research rather than qualitative for North Korean refugees, who are often very negative and uncooperative with questionnaires. 2) There is a great need to develop competence of mental health professionals who are working for North Korean refugees. 3) Most participants agreed to the necessity of longitudinal study to define the factors facilitating successful adaptation among North Korean refugees. CONCLUSION: The following are our recommendations: 1) Appropriate measurements for North Korean refugees need to be developed reflecting their uniqueness. 2) Research of North Koreans has inherent selection bias. 3) It is essential to provide primary education on mental health to North Korean refugees.

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.

Difference of Traumatic Experience according to Menstrual Regularity among North Korean Woman Refugees in South Korea

PURPOSE: This study aimed to investigate the differences of traumatic experience according to menstrual regularity among North Korean woman refugees in South Korea. METHODS: This study used a sample of convenience consisting of 131 women in 5 government resettlement centers throughout South Korea. The traumatic experiences scale for North Korean defectors was used for identifying traumatic experience. Data were collected between June 2012 and December 2012. Data was analyzed using mean, percentage, and t-test. RESULTS: The rate of irregular menstruation was 35.1%. Irregular menstruation group had more traumatic experiences than regular one (t=-1.78, p=.038). CONCLUSION: This study demonstrates that their reproductive health promotion was necessary regarding menstrual problem. Also, their severe traumatic experiences were considered into healthcare program.

The Knowledge & Attitude on Tuberculosis by Parents of North Korean Refugee Children

PURPOSE: The purpose of this study was to investigate the knowledge and attitude on tuberculosis by parents of North Korean refugees' children. METHODS: A descriptive study was conducted. Data were collected from July to November, 2014 in Hanawon and 74 North Korean refugee parents participated in the study. Data were analyzed using the SPSS 21.0. RESULTS: The score for knowledge was 17.72 out of 30 points, for awareness in attitude, 49.34 out of 60 points and for prevention behavior in attitude, 48.39 out of 60 points. There were positive significant correlations among knowledge, attitude and health interest. There was also a significant positive correlation between awareness and prevention behavior in attitude, and between prevention behavior and health interest. CONCLUSION: North Korean refugee parents showed a low level of knowledge and a negative attitude. The implication of these results is an awareness of the need for education on the causes, transmission and importance of treatment for tuberculosis. This kind of education can guide North Korean refugee parents to obtain correct information and positive attitudes and therefore, be able to effectively practice appropriate health behaviors in tuberculosis management for their children.

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.

The Construction of the Faculty of Hamheung Medical College in North Korea, 1946-48: An Unrest Coexistence of Political Ideology and Medical Expertise / 의사학

This paper aims to reveal how Hamheung Medical College in North Korea kept up its faculty with the trend of a new political system. The time period consists of three series of evaluations that occurred between the start of a reformation action in 1946 and the establishment of the regime in 1948. At the time, it was difficult to secure college faculty in the medical field, because of a serious shortage of medical personnel. Moreover, the problem in the recruitment of faculty at the medical college grew bigger since the members were required to have a high level of political consciousness. Then how did Hamheung Medical College accomplish this ideal securing of faculty that possessed political ideology and medical expertise? For the first time, a faculty evaluation at the local level was carried out and got rid of a few pro-Japanese or reactionary factions but maintained most of the faculty. Although academic background and research career of the faculty were considered, securing of the manpower in terms of number was crucial for the reconstruction of a professional school level. At the second time, as the central education bureau's intervention tightened the censorship, most of the faculty were evaluated as unqualified. Indeed, it was difficult to satisfy the standard of professionalism which emphasized a high level of academic career and political thought that included affiliation of Workers' Party of North Korea. The Medical College could not find faculty that could replace those professors and therefore, most of them maintained their faculty positions. Since then, the faculty who received excellent evaluations led the school at the very front. At the third time, the Medical College itself led the evaluations and implemented more relaxed standards of political ideology and medical expertise. Faculty who were cooperative to the reformation actions that North Korea carried forward or had working experience at the hospital and health service received a high level of recognition. Accordingly, the Medical College expanded itself by securing many professors, but also embodied a large gap of academic and ideological levels between them. Hence, the political ideology and medical expertise, which were set forth as the requirements for faculty, were constructed in the space of political ideal and social reality. Despite the high criteria the North Korean Government made, Hamheung Medical College's faculty fell below the average in terms of ideological and academic standards. As a way to compensate this, professors who greatly satisfied the both virtues were placed as leaders and, for supporting them, professors who taught the general education curriculum were recruited largely. And also, it appointed a large number of medical doctors who accumulated experiences in the field as new professors. Nevertheless, the Medical College struggled to raise the quality of medical education and was unable to prevent a part of its faculty from leaving to South Korea in the time of the Korean War. Thus, the political and academic virtues of the faculty at that time were not just simply about the professor individuals but were interrelated with the medical education and health care system in North Korea.

Task and Preparation of Psychiatric Field for Korean Reunification / 신경정신의학

For improving mental health of the future unified Korea, proper preparation would be necessary in the fields of clinical, social, and cultural psychiatry. Clinically, a diagnostic and treatment system for mental illness should be re-established after Korean unification. There should also be specific preparation for suicides, trauma- or stress-related disorders, somatizations, substance abuse, and childhood psychiatric problems which are expected to rapidly increase in North Korean areas after the unification. In the field of social psychiatry, de-stigmatization and de-institutionalization of those with mental illness would be important after the unification. Education of mental health professionals in North Korean areas would also be crucial. Culturally, it would be necessary to expect the psychological change of both South and North Koreans.

Psychiatry in Former Socialist Countries: Implications for North Korean Psychiatry

Very little information is available regarding psychiatry in North Korea, which is based on the legacy of Soviet psychiatry. This paper reviews the characteristics of psychiatry in former socialist countries and discusses its implications for North Korean psychiatry. Under socialism, psychiatric disorders were attributed primarily to neurophysiologic or neurobiological origins. Psychosocial or psychodynamic etiology was denied or distorted in line with the political ideology of the Communist Party. Psychiatry was primarily concerned with psychotic disorders, and this diagnostic category was sometimes applied based on political considerations. Neurotic disorders were ignored by psychiatry or were regarded as the remnants of capitalism. Several neurotic disorders characterized by high levels of somatization were considered to be neurological or physical in nature. The majority of "mental patients" were institutionalized for a long periods in large-scale psychiatric hospitals. Treatment of psychiatric disorders depended largely on a few outdated biological therapies. In former socialist countries, psychodynamic psychotherapy was not common, and psychiatric patients were likely to experience social stigma. According to North Korean doctors living in South Korea, North Korean psychiatry is heavily influenced by the aforementioned traditions of psychiatry. During the post-socialist transition, the suicide rate in many of these countries dramatically increased. Given such mental health crises in post-socialist transitional societies, the field of psychiatry may face major challenges in a future unified Korea.

Formation of Medical Education in North Korea: 1945-1948 / 의사학

This study focuses on the formation of medical education in North Korea from 1945 to 1948 in terms of the centralization of medical education, and on the process and significance of the systemization of medical education. Doctors of the past trained under the Japanese colonial system lived and worked as liberalists. More than half of these doctors who were in North Korea defected to South Korea after the country was liberated. Thus the North Korean regime faced the urgent task of cultivating new doctors who would 'serve the state and people.' Since the autumn of 1945, right after national liberation, Local People's Committees organized and implemented medical education autonomously. Following the establishment of the Provisional People's Committee of North Korea, democratic reform was launched, leading to the centralized administration of education. Consequently, medical educational institutions were realigned, with some elevated to medical colleges and others shut down. The North Korean state criticised the liberalistic attitude of doctors and the bureaucratic style of health administration, and tried to reform their political consciousness through political inculcation programs. The state also grant doctors living and housing privileges, which show its endeavor to build 'state medicine'. By 1947, a medical education system was established in which the education administration was put in charge of training new doctors while the health administration was put in charge of nurturing and retraining health workers. In this way, the state was the principal agent that actively established a centralized administrative system in the process of the formation of medical education in North Korea following national liberation. Another agent was deeply involved in this process - the faculty that was directly in charge of educating the new doctors. Studying the medical faculty remains another research task for the future. By exploring how the knowledge, generational experience, socio-political consciousness and world views adopted by these teachers during the colonial era were manifested in their pedagogy after national liberation will shed more light on the 'prototype' of North Korean medical education.