Identification of a novel orthonairovirus from ticks and serological survey in animals near China-North korea border.

Emerging pathogenic tick-borne viruses (TBVs) have attracted a great deal of attention due to their significant impact on human and animal health. A novel orthonairovirus named Dadong virus (DDV) was isolated from Haemaphysalis concinna ticks in the Changbai Mountain region on the China-North Korea border. DDV can induce cytopathic effects in mammalian and human cell lines. Phylogenetic analysis showed that it belongs to the genus Orthonairovirus, family Nairoviridae, exhibiting 72.4%-81.3% nucleic acid identity to Tofla orthonairovirus, known to cause lethal infection in IFNAR KO mice. The first serological evidence of DDV circulating in cattle and mice was also obtained, with 4.0% (1/25) of cattle and 2.27% (1/44) of mice seropositive for DDV. Further investigations, including serological surveys using human samples, are required to assess the public health risk posed by DDV.

North Korea's COVID-19 policy dilemma: epidemic prevention conflicting with trade.

BACKGROUND: Amidst the COVID-19 pandemic, striking a delicate balance between sustaining economic activity and safeguarding public health has become a crucial concern. The border closures for COVID-19 prevention have further intensified concerns for North Korea, which conducts over 90% of its trade with China and Russia, countries sharing its borders. METHODS: This study aims to scrutinize North Korea's response to these competing imperatives by examining the impact of border closures on the country's trade dynamics with China and Russia. This study employed the difference-in-difference (DID) method to analyze transformations in North Korea's economic activity before and after the border closures, utilizing trade data and nighttime satellite imagery captured in 2019 and 2020. RESULTS: The results reveal that North Korea actively reoriented its trade priorities towards Russia and accorded precedence to its epidemic prevention system over its economy during the pandemic. A noticeable increase in imports of food and pharmaceuticals was observed, indicating a significant rise in the inflow of these essential commodities. CONCLUSION: The findings of this study suggest that during the early stages of the COVID-19 pandemic, North Korea placed significant policy emphasis on preserving public health. However, due to economic hardships and food shortages, if the pandemic persists in the long term, it indicates the possibility of partial or complete lifting of border closures to mitigate these challenges.

Mid-Term Strategic Plan for the Public Health and Medical Care Cooperation in the Korean Peninsula.

As extensive as the concept of and the resources required for 'Health for Korean Unification' are, and due to the limited access to information on the state of health and medical care in North Korea, discussion on 'Health for Korean Unification' has tended to be intermittent and lacked concrete action plans. In this article, we specifically distinguished areas of cooperation and selected five executable agenda that meet the goals of international development cooperation: 1) Health security; 2) Easing the burden of major diseases; 3) Resilient healthcare system; 4) R&D cooperation; 5) Sustainable cooperation system. Then we provided corresponding strategic priorities and operative directions, in consideration of future military and political sanctions against North Korea. The strategies we outline are sustainable, preemptive for problems that might affect lives of South and North Korean citizens, and satisfy the unmet needs of the North Korean health system. Throughout the process, we utilized a special platform, the 'Korean Peninsula Healthcare Cooperation Platform,' designed to enable continual communication across sectors engaged in public health and medical care. By doing so, we take the first step to actually carry out the 'Health for Korean Unification,' which tended to have remained on the discussion agenda.

Novel Orthonairovirus Isolated from Ticks near China-North Korea Border.

We isolated a new orthonairovirus from Dermacentor silvarum ticks near the China-North Korea border. Phylogenetic analysis showed 71.9%-73.0% nucleic acid identity to the recently discovered Songling orthonairovirus, which causes febrile illness in humans. We recommend enhanced surveillance for infection by this new virus among humans and livestock.

Trauma and mental health among North Korean refugees living in South Korea: The role of acculturative stress.

The psychological impact of indirect trauma is unknown among North Korean (NK) refugees. We aimed to investigate the effects of direct and indirect trauma on the mental health of NK refugees in South Korea and evaluate the potential moderating effect of acculturative stress in this association. Using respondent-driven sampling, we recruited 323 NK refugees for this retrospective study. We measured exposure to direct and indirect trauma as independent variables, and posttraumatic stress symptoms (PTSS) and symptoms of depression and anxiety as dependent variables. After implementing multivariate imputation using chained equations, the associations between trauma type and psychological outcomes were assessed using ordinary least squares regression analyses, controlling for demographic covariates; the potential effect modification of acculturative stress was studied by adding an interaction term to the analyses. PTSS and symptoms of depression and anxiety were significantly associated with exposure to both direct, Bs = 0.24, 0.16, 0.19, respectively, p < .001s, and indirect trauma, Bs = 0.13, 0.08, 0.07, respectively, ps < .001. Although we did not observe significant effect modification, the magnitude of association between indirect trauma and PTSS significantly differed between the high, B = 0.18, p < .001, and low acculturative stress groups, B = 0.08, p = .024. These findings suggest that indirect trauma is associated with a more severe mental health consequence among NK refugees who experience high acculturative stress. Efforts to mitigate acculturative stress may reduce the mental health consequences of indirect trauma exposure.

Effect of a Wearable Device-Based Physical Activity Intervention in North Korean Refugees: Pilot Randomized Controlled Trial.

BACKGROUND: Effective health interventions for North Korean refugees vulnerable to metabolic disorders are currently unelucidated. OBJECTIVE: This study aimed to evaluate the effects of digital health interventions in North Korean refugees using a wearable activity tracker (Fitbit device). METHODS: We conducted a prospective, randomized, open-label study on North Korean refugees aged 19-59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to either an intervention group or a control group in a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group wore the Fitbit device but did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively. RESULTS: The trial was completed by 52 North Korean refugees, of whom 27 and 25 were in the intervention and control groups, respectively. The mean age was 43 (SD 10) years, and 41 (78.8%) participants were women. Most participants (44/52, 95.7%) had a low socioeconomic status. After the intervention, the daily step count in the intervention group increased, whereas that in the control group decreased. However, there were no significant differences between the 2 groups (+83 and -521 steps in the intervention and control groups, respectively; P=.500). The effects of the intervention were more prominent in the participants with a lower-than-average daily step count at baseline (<11,667 steps/day). After the 12-week study period, 85.7% (12/14) and 46.7% (7/15) of the participants in the intervention and control groups, respectively, had an increased daily step count (P=.05). The intervention prevented the worsening of the metabolic parameters, including BMI, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period. CONCLUSIONS: The wearable device-based physical activity intervention did not significantly increase the average daily step count in the North Korean refugees in this study. However, the intervention was effective among the North Korean refugees with a lower-than-average daily step count; therefore, a large-scale, long-term study of this intervention type in an underserved population is warranted. TRIAL REGISTRATION: Clinical Research Information Service KCT0007999; https://cris.nih.go.kr/cris/search/detailSearch.do/23622.

A Three-Year Longitudinal Study of Risk Factors for Suicidality in North Korean Defectors.

BACKGROUND: This longitudinal study examined risk factors for future suicidality among North Korean defectors (NKDs) living in South Korea. METHODS: The subjects were 300 NKDs registered with a regional adaptation center (the Hana Center) in South Korea. Face-to-face interviews were conducted using the North Korean version of the World Health Organization's Composite International Diagnostic Interview to diagnose mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Subjects were also asked about sociodemographic and clinical factors at baseline. At follow-up after three years, the NKDs (n = 172 respondents) were asked to participate in an online survey, responding to self-questionnaires about suicidality. Logistic regression analyses were used to explore associations between baseline variables and future suicidality among NKDs. RESULTS: Thirty (17.4%) of the 172 survey respondents reported suicidality at follow-up. The presence of health problems over the past year, any prior suicidality at baseline, a higher score on a trauma-related scale, and a lower score on a resilience scale at baseline were associated with greater odds of suicidality at follow-up after adjusting for age, sex, and educational level. Of all mental disorder categories, major depressive disorder, dysthymia, agoraphobia, and social phobia were also associated with significantly increased odds of suicidality at follow-up after adjusting for age, sex, educational level, and prior suicidality at baseline. CONCLUSION: Resilience, a previous history of suicidality, and the presence of lifetime depressive disorder and anxiety disorder should be given consideration in mental health support and suicide prevention in NKDs.

Seroprevalence of Hepatitis C Virus Infection in North Korean Defectors Residing in Korea.

BACKGROUND: This study aimed to investigate the prevalence rate of hepatitis C virus (HCV) infection and identify the demographic, and sociological characteristics and changes in awareness of HCV infection by participating the study for North Korean defectors residing in South Korea. METHODS: This study prospectively enrolled participants. Demographic, sociological and clinical data, and questionnaire surveys focused on awareness of HCV infection were collected. RESULTS: In total, 211 North Korean defectors participated in this study from September 2020 until June 2021. There were 174 women (82.5%), and the overall mean age was 48.9 years (range, 20 to 80 years). Of these participants, 112 (53.1%) had immigrated to South Korea since 2011. The overall prevalence of anti-HCV antibody among North Korean defectors was 1.9%. Thirty participants (14.2%) had hepatitis B surface antigens. A huge lack of awareness regarding HCV infection has been observed among North Korean defectors. CONCLUSION: This is the first prospective study to investigate the prevalence rate of HCV infection among North Korean defectors residing in South Korea. As North Korean defectors are a vulnerable group concerning HCV infection, they may benefit from HCV screening policies and educational interventions for HCV infection.

The rocky road to freedom: number of countries transited during defection and risk of metabolic syndrome among North Korean Refugees in South Korea.

OBJECTIVES: North Korean Refugees (NKRs) undergo defection, and this has been shown to impact their current health status in South Korea. However, little is understood about how the defection process is related to metabolic syndrome (MetS). This study regarded the defection process to be a quasi-measurement of traumatic experience and investigated whether defection was a risk factor for MetS among NKRs living in South Korea. STUDY DESIGN: This cross-sectional study obtained data from the Korea University Anam Hospital in Seoul. NKRs (N = 847) voluntarily completed questionnaires and underwent at least one medical examination between October 2008 and July 2021. METHODS: Multivariable logistic regression models were used to evaluate whether the number of countries transited by NKRs was associated with MetS by controlling for covariates. RESULTS: The prevalence of MetS among male and female NKRs in South Korea was 12.3% and 13.3%, respectively. The highest prevalence of MetS (33.4%) was among NKRs who had transited two countries. The number of months in transit countries (mean: 49.9 ± 51.7) and period of residence in South Korea (mean: 40.9 ± 40.9 months) were also considered. NKRs who transited three countries had a higher probability of MetS (odds ratio [OR] 2.660, 95% confidence interval [CI] 1.161-6.097) than those who travelled directly to South Korea. NKRs who transited three countries and had only resided in South Korea for a short period had a higher probability of MetS (OR 3.424, 95% CI 1.149-10.208) than those who have lived in South Korea for a longer period. CONCLUSIONS: Considering the social vulnerability of NKRs and consequential health problems, there is an urgent need for appropriate support from the government and society.

The growth status of North Korean refugee adolescents in South Korea: comparison with South Korean adolescents.

AIM: To assess the growth status of North Korean refugee adolescents (NKRA) living in South Korea (SK) and compare their growth status with that of SK adolescents (SKA). SUBJECTS AND METHODS: NKRA were interviewed from 2017 to 2020, whereas the data for SKA were from the 2016 to 2018 Korea National Health and Nutrition Examination Surveys. SKA and NKRA were matched by age and gender in a 3:1 ratio and 534 SKA and 185 NKRA were enrolled. RESULTS: After adjusting for the covariates, NKRA had greater prevalences of thinness (odds ratio [OR], 11.5; 95% confidence interval [CI], 2.9-45.6) and obesity (OR, 12.0; 95% CI, 3.1-46.1) than SKA, but were not of short stature. In comparison with SKA in low-income families, NKRA had similarly greater prevalences of thinness and obesity, but not of short stature. As the length of stay of NKRA in SK increased, the prevalence of short stature and thinness did not decrease, while the prevalence of obesity increased significantly. CONCLUSION: Although they had lived in SK for several years, NKRA had greater prevalences of thinness and obesity than SKA and the prevalence of obesity increased significantly with the length of stay in SK.

Relations of Vocabulary and Cognitive Skills With Reading Performance of North Korean Students in South Korean Schools.

We examined if North (n = 123) and South Korean (n = 123) children in Grades 3 to 8 studying in South Korea differ in their reading, vocabulary, and literacy-related cognitive skills, and whether language and literacy-related skills contribute to reading outcomes differently among North and South Korean children. The results showed that South Korean students performed better in syllable deletion, RAN-Letters, vocabulary, decoding fluency, and reading comprehension after controlling for age and SES. No differences were observed in phonological awareness, RAN-Digits, and visual processing tasks. A multigroup path analysis showed that phonological awareness and vocabulary were more strongly associated with decoding fluency for the South than the North Korean students, whereas the opposite was true for visual processing. The results suggest that South Korean vocabulary knowledge may be a significant factor in addressing the academic difficulties facing North Korean children in South Korean schools and that it is important to consider linguistic characteristics when examining the variations in reading skills and vocabulary knowledge of North Korean students in South Korean schools. These findings have implications for North Korean children's literacy instruction in South Korean schools.

'I worked until my body was broken': an ethnomedical model of chronic pain among North Korean refugee women.

OBJECTIVES: While increasing numbers of North Korean refugees (NKRs) are migrating to South Korea, different understandings of physical pain between NKR patients and the South Korean healthcare providers may create miscommunication and less satisfaction with their care management. To identify strategies to improve care, this study elicits and presents an ethnomedical model of chronic pain among NKR women. DESIGN: Twenty semi-structured individual interviews were conducted with NKR women with chronic pain living in South Korea. Inductive and deductive thematic analysis was performed on three types of data: interview transcripts, field notes created after each interview, and memos written during the analysis. RESULTS: Participants reported that pain started after a certain period of resettlement and expressed frustration when there was no definite diagnosis for pain. They identified physical factors (e.g. excessive labor, exposure to violence, and poor diet) as the primary causes, while psychological factors (e.g. loneliness, rumination, and financial burden of sending remittances to North Korea) were viewed as collateral or contributing causes. Several participants indicated emotional discomfort when they were referred to psychiatrists for unceasing pain. Physical treatment (injections, medications, or acupuncture) and providers' sincere attitudes were expectations of care considered capable of addressing both physical and emotional distress. CONCLUSIONS: Findings highlight the need to understand NKR women's ethnomedical model of chronic pain, which is distinct from illness model of healthcare providers. These preliminary findings could be used to improve care strategies based on NKRs' care needs.

The Possible Impact of Nationwide Vaccination on Outcomes of the COVID-19 Epidemic in North Korea: A Modelling Study.

BACKGROUND: The Democratic People's Republic of Korea (North Korea) had successfully suppressed the coronavirus disease 2019 (COVID-19) epidemic via border closures. However, a rapid surge in incidence was reported due to the spread of the omicron variant (B.1.1.529), leading to a national emergency declaration in May 2022. Moreover, with the lack of vaccine accessibility and medical facilities, it is unclear how the disease burden may be exacerbated. Despite the limited epidemiological data, we aimed to project the COVID-19 transmissions in North Korea and quantify the potential impact of nationwide vaccination, comparing epidemiological outcomes via scenario analysis. METHODS: A discrete-time deterministic compartmental model was used. The parameters were calibrated using empirical data. Numerical simulations incorporated nationwide COVID-19 vaccination into the proposed model with various asymptomatic proportions. RESULTS: Our model suggested that the stringent public health and social measures (PHSMs) reduced the severe acute respiratory syndrome coronavirus 2 transmissibility by more than 80% in North Korea. Projections that explicitly incorporated vaccination indicated that nationwide vaccination would be necessary to suppress a huge resurgence in both COVID-19 cases and hospitalizations after the stringent PHSMs are eased. Moreover, vaccinating more than 80% of the population with two doses may keep the peak prevalence of hospitalizations below 1,500, averting more than 40,000 hospitalizations across all scenarios. CONCLUSION: Nationwide vaccination would be essential to suppress the prevalence of COVID-19 hospitalizations in North Korea after the stringent PHSMs are lifted, especially in the case of a small asymptomatic proportion.

Research topics in intellectual disabilities in North Korea: A scoping review.

BACKGROUND: Research outcomes on intellectual development and related disabilities in North Korea are not widely known. Therefore, the current scoping review aimed to provide preliminary insight on research topics concerning intellectual disabilities in North Korea. METHOD: A six-stage framework for scoping review was adopted to examine research trends. Articles were categorised based on the era of supreme leader and research topic. RESULTS: There is a greater amount of research regarding intellectual disabilities in the recent Kim Jong-un era compared to the period of the previous leader where research outcomes on general intelligence were the focus. Significant qualitative progress was similarly found. CONCLUSIONS: The current analysis on research outcomes provides meaningful insights to aid in understanding the atmosphere in North Korea surrounding intellectual disabilities. Follow-up studies and open discussions are necessary for further progress.

Development of international nursing standard-based curriculum for North Korean nurses.

BACKGROUND: The types of nursing care and education have been advanced in different ways between South and North Korea during the past 73 years following division of Korea. The contents of the nursing education curriculum in North Korea do not match international standards. In preparation for the unification of the two Koreas, identifying and examining North Korean nursing education are needed. AIM: To develop a curriculum for North Korean nurses to in accordance with the international nursing standards. METHODS: This study consisted of two phases. First, we reviewed the literature, analyzed in-depth interviews with North Korean nurse defectors, and evaluated the contents and scope of nursing education in North Korea. Next, we developed a nursing education curriculum for North Korea through discussion with nursing education experts. RESULTS: The nursing curriculum for North Korean nurses comprised 96 credits (21 credits for fundamental major courses and 75 credits for mandatory major courses) according to the standards of the Korea Institute of Nursing Education and Evaluation. The proposed curriculum I comprised 84.5 credits, with 14.5 credits for major courses and 70 credits for mandatory major courses. Proposed curriculum II considered the capabilities and clinical experiences of North Korean nurses and comprised 52 credits with 6 credits for major courses and 46 credits for mandatory major courses. CONCLUSION: A nursing curriculum was proposed to match the nursing practice competencies of North Korean nurses to international standards. This curriculum can be expected to improve the quality of nursing care in North Korea, facilitate the integration of nursing workforces, and ultimately promote the health of the people during unification. IMPLICATIONS FOR NURSING POLICY: The nursing curricula proposed in this study could be a significant measure to nurture nursing manpower and contribute to narrowing the nursing gaps between South and North Korea in the process of Korea's unification.

Role of AmpG in the resistance to ß-lactam agents, including cephalosporins and carbapenems: candidate for a novel antimicrobial target.

BACKGROUND: A complex cascade of genes, enzymes, and transcription factors regulates AmpC ß-lactamase overexpression. We investigated the network of AmpC ß-lactamase overexpression in Klebsiella aerogenes and identified the role of AmpG in resistance to ß-lactam agents, including cephalosporins and carbapenems. METHODS: A transposon mutant library was created for carbapenem-resistant K. aerogenes YMC2008-M09-943034 (KE-Y1) to screen for candidates with increased susceptibility to carbapenems, which identified the susceptible mutant derivatives KE-Y3 and KE-Y6. All the strains were subjected to highly contiguous de novo assemblies using PacBio sequencing to investigate the loss of resistance due to transposon insertion. Complementation and knock-out experiments using lambda Red-mediated homologous recombinase and CRISPR-Cas9 were performed to confirm the role of gene of interest. RESULTS: In-depth analysis of KE-Y3 and KE-Y6 revealed the insertion of a transposon at six positions in each strain, at which truncation of the AmpG permease gene was common in both. The disruption of the AmpG permease leads to carbapenem susceptibility, which was further confirmed by complementation. We generated an AmpG permease gene knockout using lambda Red-mediated recombineering in K. aerogenes KE-Y1 and a CRISPR-Cas9-mediated gene knockout in multidrug-resistant Klebsiella pneumoniae-YMC/2013/D to confer carbapenem susceptibility. CONCLUSIONS: These findings suggest that inhibition of the AmpG is a potential strategy to increase the efficacy of ß-lactam agents against Klebsiella aerogenes.

Chronic respiratory disease mortality and its associated factors in selected Asian countries: evidence from panel error correction model.

BACKGROUND: Chronic Respiratory Diseases (CRDs) in Asian countries are a growing concern in terms of morbidity and mortality. However, a systematic understanding of the increasing age-adjusted mortality rate of chronic respiratory disease (CRD) and its associated factors is not readily available for many Asian countries. We aimed to determine country-level factors affecting CRD mortality using a panel error correction model. METHODS: Based on data from the Global Burden of Disease Study 2017, we estimated the trends and distribution of CRD mortality for selected Asian countries from 2010 to 2017. Furthermore, we evaluated the relationship between CRD mortality and Gross Domestic Product (GDP) per capita, average years of schooling, urbanization, and pollutant emission (PM2.5 concentration) using a fixed-effect model. We corrected the estimates for heteroscedasticity and autocorrelation through Prais-Winsten adjustment along with robust standard error. RESULTS: Between 2010 and 2017, approximately 21.4 million people died from chronic respiratory diseases in the countries studied. Age-standardized crude mortality rate from CRDs in the period had minimum and maximum values of 8.19 (Singapore in 2016) and 155.42 (North Korea in 2010) per 100,000 population, respectively. The coefficients corrected for autocorrelation and heteroskedasticity based on the final model of our study (Prais-Winsten), showed that all explanatory variables were statistically significant (p < 0.001). The model shows that the 1% increase in GDP per capita results in a 20% increase (0.203) in the CRD mortality rate and that a higher concentration of air pollution is also positively associated with the CRD deaths (0.00869). However, an extra year of schooling reduces the mortality rate by 4.79% (- 0.0479). Further, rate of urbanization is negatively associated with the CRD death rate (- 0.0252). CONCLUSIONS: Our results indicate that both socioeconomic and environmental factors impact CRD mortality rates. Mortality due to CRD increases with rising GDP per capita and decreases with the percentage of the total population residing in urban areas. Further, mortality increases with greater exposure to PM2.5. Also, higher years of schooling mitigate rising CRD mortality rates, showing that education can act as a safety net against CRD mortality. These results are an outcome of sequential adjustments in the final model specification to correct for heteroscedasticity and autocorrelation.

Characteristics and Distribution of Surgical Diseases in North Korean Research Papers Published between 2006 and 2017.

BACKGROUND: Little is known about the surgical discipline in North Korea from the perspective of the outside world. This study aimed to examine the disease entities covered by articles published in the major medical journal in North Korea, "Surgery." METHODS: Content and frequency analyses of 2,132 articles published in "Surgery" from 2006 to 2017 were conducted. Two medical doctors who majored in surgery and anesthesiology perused the articles and compiled the diseases being elucidated in each article. The diseases described in each article were stratified into 13 surgical subspecialties. RESULTS: Articles from "Surgery," similar to articles from the Western surgical community, also covered a wide variety of surgical diseases from different subspecialties, and the number of publications continued to grow consistently. Moreover, a number of studies focused on the fields of orthopedics and general surgery dealing with benign diseases. Some articles focused on minimally invasive surgeries using laparoscopy. CONCLUSION: The studies published in the North Korean journal "Surgery" encompass various clinical areas, but their quality is unclear.

Trend of Disease Burden of North Korean Defectors in South Korea Using Disability-adjusted Life Years from 2010 to 2018.

BACKGROUND: This study aimed to examine the disease burden of North Korean defectors in South Korea by sex, age, and disease from 2000 to 2018 and to study the changes in the disease burden over time. METHODS: Based on the incidence-based disability-adjusted life year (DALY) developed in a Korean National Burden of Disease (KNBD) study, we calculated the years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for approximately 22,753 North Korean defectors in South Korea whose claims data were available from the National Health Insurance Service (NHIS). RESULTS: In 2018, the rates of YLL, YLD, and DALY for North Korean defectors per 100,000 population was 3,763 (male 8,491; female 2,404), 37,683 (male 27,742; female 40,539), and 41,446 (male 36,233; female 42,943), respectively. Major depressive disorders constituted the highest DALY, followed by cirrhosis of the liver and low back pain. The disease burden of North Korean defectors consistently decreased from 2010 to 2018. The decrease in YLD contributed to the overall decline in DALY per 100,000 population in 2018, which decreased by 25.2% compared to that in 2010. CONCLUSION: This is the first study to measure the disease burden of North Korean defectors in South Korea. Given the decreasing or substantially increasing trends in disease burden, it is necessary to establish appropriate public health policies in a timely manner, and the results of this study provide a basis for the development of customized public health and healthcare policies for North Korean defectors in South Korea.

Heart Rate Variability after Treatment for Depression in North Korean Defectors.

North Korean Defectors (NKDs) are known to experience multiple psychological symptoms such depression and anxiety. Heart rate variability (HRV) has been implicated in various psychiatric disorders, including posttraumatic stress disorder (PTSD) and depression. No studies have prospectively evaluated HRV parameters in NKDs. We recruited 34 NKDs (2 men, 32 women; age range 25-58 years) who were diagnosed with major depressive disorder. We evaluated psychiatric symptoms using the Korean version of the Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale, and PTSD checklist civilian version. We also performed HRV measurements before and after 12 weeks of antidepressant treatment. In the baseline, HDRS item 14 and 15 showed statistically significant positive correlation with LF/HF ratio. At the endpoint, HDRS item 5 and 8 were found to have positive correlations with some HRV parameters. We found that the sum of fatigue-related HDRS symptoms scores (number 7 and 13) showed significant positive correlation with LF. HDRS total scores also showed significant positive correlations with LF and HF. When the severity of depression was decreased and only the PTSD symptoms persisted at the endpoint, the relationships between HRV and clinical measures were more clearly revealed. This study shows the possibility of using HRV as an objective neurobiological index of autonomic nervous system disorder and reaction to stress in NKDs.