Medical Expenses of North Korean Defectors with Post-Traumatic Stress Disorder.

OBJECTIVE: The purpose of this study was to establish the prevalence of PTSD among North Korean defectors who visited the National Medical Center, Seoul, South Korea over a period of approximately 10 years by examining their medical records and to examine differences in the medical service usage patterns of patients with and without PTSD. METHODS: Data from North Korean defectors who used outpatient services at the National Medical Center during a period of 10 years and 3 months (January 1 2006 to February 28, 2016) were analyzed. The general characteristics of the defectors were analyzed by frequency analyses, and descriptive statistics were generated. Additionally, independent t-tests and chi square analyses were performed to examine differences between PTSD patients and those without PTSD. Linear regression analysis was performed to examine factors affecting the mental health of North Korean defectors suffering from PTSD. RESULTS: This study assessed the correlations between PTSD, the average number of outpatient visits, and the total revenue. The regression analysis showed a relationship between PTSD and the average number of outpatient visits. There was also a correlation between PTSD and total revenue. The average number of outpatient visits was 41.8 for PTSD patients, whereas it was 33.2 for those without PTSD. The total revenue visit was 953.6 USD for PTSD sufferers and 231.1 USD for those without PTSD. CONCLUSION: This study found that the majority of North Korean defectors visit psychiatry departments, and that PTSD patients use outpatient services more frequently and have higher total revenue than those without PTSD. Additionally, patients with PTSD used a greater variety of medical services. Considering the high medical care expenses of North Korean defectors residing in South Korea, future investigations should examine the medical service usage patterns of such patients, especially those diagnosed with PTSD, in greater detail.

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.

Factors Related to the Attitude of North Korean Refugees Towards People with Mental Illness.

BACKGROUND: The purpose of this study was to explore the level of mental health knowledge among North Korean refugees residing in South Korea and to analyze the factors related to their attitude towards people with mental disorders. METHODS: The survey was conducted on 150 people and the analysis included results from 138 participants in 2013. A multiple linear regression analysis was conducted to analyze the factors related to the attitude towards people with mental illness. RESULTS: The education level attained in South Korea and the duration of stay in the South were effective factors associated with anti-authoritarianism. Age, marital status, education level in the North, and level of mental health knowledge were significant factors for benevolence. Time spent in South Korea and knowledge of mental health played a significant role in determining their attitude towards social restrictiveness (P=0.014). CONCLUSION: The knowledge of mental illness in refugees was associated with their attitude towards people with mental illness. This study suggests the need to educate refugees on mental illness to enhance their attitudes.

The Effects of Discrimination Experience on Life Satisfaction of North Korean Refugees: Mediating Effect of Stress.

OBJECTIVE: This study investigated the mediation effect of stress between the experience of discrimination and life satisfaction among North Korean refugees who resettled in South Korea. The findings of the current study provide empirical evidence for the need of social interventions to mitigate adverse effects of stress on North Korean refugees who are subject to social discrimination on a daily basis. METHODS: In this study, we included 500 subjects among 2,138 North Korean refugees who took refuge in South Korea in 2007. The interview started from April 6th 2009 and finished on May 25th 2009. We conducted moderator effect analysis with Path analysis was conducted because we confirm the experience of discrimination was affected by life satisfaction and stress can affected life satisfaction as a moderator. RESULTS: The experience of discrimination significantly affects stress and stress significantly affects life satisfaction. However, the experience of discrimination was not directly related to life satisfaction. The more stress the study respondents experienced, the lower the life satisfaction they reported. CONCLUSION: The present finding suggests that the effects of discriminating experiences on the life satisfaction of North Korean refugees in South Korea were mediated by their own perceived stress.

Health-Promoting Behavior and Influencing Factors in Young North Korean Refugees (NKRs) Living in South Korea.

The number of young North Korean refugees (NKRs) entering South Korea to escape famine and poverty and improve their quality of life is drastically increasing. The aims of this study were to identify and compare health promoting lifestyle behaviors (HPLBs) of young NKRs, compared to South Koreans, and to investigate influencing factors related to HPLBs in young NKRs. Data were obtained from 150 NKRs residing in South Korea and 161 South Koreans. Respondents provided their psychological status (depression, stress, and life satisfaction) and HPLBs. The NKRs reported lower interpersonal relations scores and higher spiritual growth scores compared to the control group. Attendance in religious services, stress, and life satisfaction were significantly associated with HPLBs in young NKRs. Health education and/or promotion programs focusing interpersonal relations and spiritual growth may be beneficial. In addition, regular psychological health screening is proposed as part of health-checkup programs, potentially improving adjustment to South Korean society.

Gender Differences and Socioeconomic Factors Related to Osteoporosis: A Cross-Sectional Analysis of Nationally Representative Data.

BACKGROUND: Osteoporosis has been considered a disease that primarily affects women, but recently male osteoporosis is also attracting attention. This study aims to comparatively analyze socioeconomic and other factors that are related to the prevalence of osteoporosis in both men and women. MATERIALS AND METHODS: This study used data from the Korean Community Health Survey conducted in 2013. To determine factors related to osteoporosis prevalence, researchers applied a binary logistic regression model, first for all research participants, then separately for male and female participants. RESULTS: Women were more likely than men to have osteoporosis (odds ratio 12.33, 95% confidence interval 11.55-13.17). Factors related to osteoporosis prevalence included age, education level, region, economic activity, alcohol consumption, salt intake, depression, and body mass index in both genders. Low education and income levels were more highly associated with osteoporosis prevalence in women than in men. CONCLUSIONS: Most of the factors were not gender specific, but some socioeconomic determinants varied by gender. Future studies that will focus on the effects of socioeconomic factors on osteoporosis, as well as gender-related differences in prevention and control of osteoporosis, are needed.

Gender Differences in Suicidal Ideation and Related Factors among North Korean Refugees in South Korea.

OBJECTIVE: According to previous social survey, a high number of North Korean refugees (NKRs) in South Korea had suicidal ideation. The purpose of this study is to examine the related factors for suicidal ideation among NKRs by gender in South Korea. METHODS: We examined the sample of NKRs, 701 subjects (men=160, women=-541) residing in South Korea, the participants were enrolled from October 2008 to May 2014. The related factors with suicidal ideation in NKRs were analyzed via a logistic regression analysis. RESULTS: Refugee women were more likely to have suicidal ideation than men were. Although thoughts of suicide do not necessarily mean that they will follow through, however, there is an association that the higher rate of suicide also results in a higher rate of attempted suicide. In both genders, they tended to think more frequently about suicide who had stayed in South Korea for more than 5 years. In addition, higher frequencies of suicidal ideation also associated with higher level of perceived stress in both genders. CONCLUSION: The gender difference should be addressed when designing suicide prevention interventions among the North Korean population in South Korea.

Gender Differences in Outpatient Utilization: A Pooled Analysis of Data from the Korea Health Panel.

BACKGROUND: This study aims to set itself apart from prior research by elucidating gender differences in outpatient service utilization among adults aged 20 years or older, using nationally representative survey data. METHODS: Data from the Korea Health Panel (KHP) collected between 2010 and 2011 were used. In this study, all KHP participants who accessed outpatient service between 2010 and 2011 were included; 13,525 participants used outpatient services in 2010 and 12,991 in 2011. To analyze factors related to outpatient utilization, regression analysis was performed using generalized estimating equations. RESULTS: The use frequency of outpatient service was significantly associated with age, education level, marital status, economic activity, health insurance status, drinking, presence of chronic disease, and self-rated health status in both sexes (p < 0.05). Annual household income significantly affected outpatient utilization only among women. CONCLUSIONS: Unlike males, females with higher household incomes used outpatient services more. This suggests that females are at greater risk of medical inequality based on economic circumstances.

Mutational burdens and evolutionary ages of thyroid follicular adenoma are comparable to those of follicular carcinoma.

Follicular thyroid adenoma (FTA) precedes follicular thyroid carcinoma (FTC) by definition with a favorable prognosis compared to FTC. However, the genetic mechanism of FTA to FTC progression remains unknown. For this, it is required to disclose FTA and FTC genomes in mutational and evolutionary perspectives. We performed whole-exome sequencing and copy number profiling of 14 FTAs and 13 FTCs, which exhibited previously-known gene mutations (NRAS, HRAS, BRAF, TSHR and EIF1AX) and copy number alterations (CNAs) (22q loss and 1q gain) in follicular tumors. In addition, we found eleven potential cancer-related genes with mutations (EZH1, SPOP, NF1, TCF12, IGF2BP3, KMT2C, CNOT1, BRIP1, KDM5C, STAG2 and MAP4K3) that have not been reported in thyroid follicular tumors. Of note, FTA genomes showed comparable levels of mutations to FTC in terms of the number, sequence composition and functional consequences (potential driver mutations) of mutations. Analyses of evolutionary ages using somatic mutations as molecular clocks further identified that FTA genomes were as old as FTC genomes. Whole-transcriptome sequencing did not find any gene fusions with potential significance. Our data indicate that FTA genomes may be as old as FTC genomes, thus suggesting that follicular thyroid tumor genomes during the transition from FTA to FTC may stand stable at genomic levels in contrast to the discernable changes at pathologic and clinical levels. Also, the data suggest a possibility that the mutational profiles obtained from early biopsies may be useful for the molecular diagnosis and therapeutics of follicular tumor patients.

Whole-exome sequencing identifies recurrent AKT1 mutations in sclerosing hemangioma of lung.

Pulmonary sclerosing hemangioma (PSH) is a benign tumor with two cell populations (epithelial and stromal cells), for which genomic profiles remain unknown. We conducted exome sequencing of 44 PSHs and identified recurrent somatic mutations of AKT1 (43.2%) and ß-catenin (4.5%). We used a second subset of 24 PSHs to confirm the high frequency of AKT1 mutations (overall 31/68, 45.6%; p.E17K, 33.8%) and recurrent ß-catenin mutations (overall 3 of 68, 4.4%). Of the PSHs without AKT1 mutations, two exhibited AKT1 copy gain. AKT1 mutations existed in both epithelial and stromal cells. In two separate PSHs from one patient, we observed two different AKT1 mutations, indicating they were not disseminated but independent arising tumors. Because the AKT1 mutations were not found to co-occur with ß-catenin mutations (or any other known driver alterations) in any of the PSHs studied, we speculate that this may be the single-most common driver alteration to develop PSHs. Our study revealed genomic differences between PSHs and lung adenocarcinomas, including a high rate of AKT1 mutation in PSHs. These genomic features of PSH identified in the present study provide clues to understanding the biology of PSH and for differential genomic diagnosis of lung tumors.

Mini-plate removal in maxillofacial trauma patients during a five-year retrospective study.

OBJECTIVES: The purpose of this study was to analyze the incidence of indications for the removal of mini-plates over a five-year period in maxillofacial trauma patients. MATERIALS AND METHODS: The medical records of 530 patients who underwent treatment with mini-plate fixation after maxillofacial trauma were reviewed for a five-year period (May 2007 to May 2012). Patients were evaluated concerning the number of mini-plates removed, age and gender distributions, time between insertion and removal, indication for removal, and site of removal. RESULTS: The plates of 120 patients were removed (26 females and 94 males). The removal rate was 22.6%. The most frequent indication for removal was patient demand (81.7%), followed by tooth extraction (7.5%), and pain (3.3%). The most frequent removal site was the mandible (95.0%). CONCLUSION: The number of mini-plates removed was small, and the most common indication for removal was patient demand. There is no evidence to support a recommendation for the routine removal of titanium mini-plates.

Early Bone Formation at a Femur Defect Using CGF and PRF Grafts in Adult Dogs: A Comparative Study.

PURPOSE: The purpose of this study was to compare the predictability of new bone formation using an autologous concentrated growth factor (CGF) graft alone and platelet graft alone. MATERIALS AND METHODS: Four bony defects of 8 mm were formed, and 3.7- × 10-mm implants were placed in the right femur. The platelet-rich fibrin (PRF), CGF, and synthetic bone were grafted to the bone defect area. Enzyme linked immunosorbent assay quantitative analysis and microscopic analysis of the fibrinogen structure were performed. RESULTS: At 4 weeks, the comparisons of each experimental group showed a significant difference between the CGF group and the synthetic bone graft group. When comparing the CGF and allograft material groups, the allograft group showed significantly more new bone formation. In the case of vascular endothelial growth factor, CGF had 1.5 times more than PRF. CGF showed a fibrinogen structure with a constant diameter. CONCLUSION: When applied to a clinical case, CGF is predicted to show better results than PRF.

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

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 study of mental health literacy among North Korean refugees in South Korea.

OBJECTIVES: This study aimed to investigate North Korean refugees' knowledge of mental illnesses and treatments and analyze the factors affecting this knowledge. METHODS: Subjects were selected via a snowball sampling method, and the survey outcomes of 152 North Korean refugee participants were analyzed. The factors affecting knowledge of mental illnesses were analyzed via a regression analysis by constructing a multivariate model with mental illness knowledge score as the dependent variable. RESULTS: The North Korean refugees' mental illness scores ranged from 3 to 24 points, with an average score of 13.0. Regarding the factors that influence mental illness knowledge, the subjects with South Korean spouses and those who had spent more time in South Korea had higher knowledge scores. Furthermore, the subjects who considered the mental health of North Korean refugees to be a serious issue revealed lower knowledge scores than those who did not believe it was a serious issue. The subjects who visit psychiatric clinics showed higher knowledge scores than those who do not. The South Korean subjects who had at least a college education exhibited higher scores than did those without advanced education. The subjects who are satisfied with life in South Korea manifested a higher mental illness knowledge score than those who are not. CONCLUSIONS: This study is significant as being the first study to ever measure and evaluate the level of North Korean refugees' knowledge of mental illnesses. In addition, the evaluations of North Korean refugees' mental illness knowledge and influencing factors while residing in South Korea created basic data that formed the foundation of an effort to enhance mental health literacy and provide proper mental health services. The results of this study can be utilized to solve mental health problems that might frequently occur during the unification process of North and South Korea in the future.

Three-dimensional volumetric analysis after sinus grafts.

PURPOSE: The purpose of this study was to evaluate the augmentation volume of a sinus graft according to the time and graft materials based on cone-beam computed tomography (CBCT) scans and to assess efficacy of a bioabsorbable membrane. METHODS: Fourteen patients were investigated, and volumetric analysis was performed using OnDemand 3DTM software (Cybermed, Seoul, Korea). CBCT scans were performed on patients before surgery, immediately after surgery, 6 months after surgery, and 1 year after surgery. Following this analysis, the volumetric data were compared with the actual grafted volumes. Bioabsorbable membranes were used in all patients to promote the protection of sinus membranes and to guide bone regeneration. RESULTS: Overall, the average percent volume of graft material that remained 6 months after implantation was 82.0%, and the average percent volume of graft material that remained 1 year after surgery was 60.4%. These reductions in the volume of graft material from immediately after surgery until 6 months or 1 year after surgery were shown to be statistically significant (P = 0.002 and P < 0.001, respectively). CONCLUSION: The slight differences observed among the data indicate that volumetric analysis performed using CBCT can provide highly accurate data. A significant difference was observed in volumetric change over time, but no significant differences were observed between materials. No significant relationship was observed between the resorption of grafted bone and the success rate.