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.

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

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

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

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

Nursing College Life Experiences of North Korean Defectors

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

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.

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.

To Eradicate Malaria on the Korean Peninsula, Accurate Democratic People's Republic of Korea Malaria Statistics Are Needed

No abstract available.

The Socialist Camp's North Korean Medical Support and Exchange (1945–1958): Between Learning from the Soviet Union and Independent Course / 의사학

This study focused on the socialist camp's North Korean medical support and its effects on North Korean medical field from liberation to 1958. Except for the Soviet assistance from liberation to the Korean War, existing studies mainly have paid attention to the ‘autonomous’ growth of the North Korean medical field. The studies on the medical support of the Eastern European countries during the Korean War have only focused on one-sided support and neglected the interactions with the North Korean medical field. Failing in utilizing the materials produced in North Korea has led to the omission of detailed circumstances of providing support. Since the review of China's support and the North Korea-China medical exchanges has been concentrated in the period after the mid-1950s, the impacts of China's medical support on North Korea during the Korean War period and the post-war recovery period have not been taken into account. In terms of these limitations, this study examined the medical activities by the Socialist camp of the Eastern European countries in North Korea after the Korean War. The medical aid teams from Hungary, Romania, Bulgaria, Czechoslovakia, Poland, and East Germany that came to North Korea in the wake of the Korean War continued to stay in North Korea after the war to build hospitals and train medical personnel. In the hospitals operated by these countries, cooperative medical care with North Korean medical personnel and medical technology education were conducted. Moreover, medical teams from each country in North Korea held seminars and conferences and exchanged knowledge with the North Korean medical field staffs. These activities by the Socialist countries in North Korea provided the North Korean medical personnel with the opportunity to directly experience the medical technology of each country. China's support was crucial to North Korea's ‘rediscovery’ of Korean medicine in the mid-1950s. After the Korean War, North Korea began to apply the Chinese-Western medicine integration policy, which was performed in China at that time, to the North Korean health care field through China's medical support and exchanges. In other words, China's emphasis on Chinese medicine and the integration of the Chinese-Western medicine were presented as one of the directions for medical development of North Korea in the 1950s, and the experiences of China in this process convinced North Korea that Korean medicine policy was appropriate. The decision-makers of the North Korean medical policies, who returned to North Korea after studying abroad in China at that time, actively introduced the experiences from China and constantly sought to learn about them. This study identified that a variety of external stimuli had complex impacts on the North Korean medical field in the gap between ‘Soviet learning’ in the late 1940s and the ‘autonomous’ medical development since the 1960s. The North Korean medical field was formed not by the unilateral or dominant influences of a single nation but by the stimulation from many nations and the various interactions in the process.

The Awareness of Contraception and Experience of Oral Contraceptives among North Korean Defector Women in Republic of Korea

OBJECTIVE: This study attempts to gauge the necessity of contraceptive education for women defecting from North Korea (NKDWs). METHODS: We conducted in-depth interviews with six NKDWs who had lived in the Republic of Korea (ROK) for more than three years, to understand the subjects' perceptions, experiences, and opinions regarding contraception. Thematic analyses were performed using qualitative data provided in the survey results. RESULTS: Before their defections from North Korea, none of the NKDWs had received any sex education. Loop is the only contraceptive method available to married women in ROK. After defection, NKDWs were provided information about contraceptive options available in China, but they could not fully understand this information. Furthermore, the information they received was not accurate. Thus, NKDWs had a high need for contraceptive sex education. As per our survey, their preferred education method was at least 3 lessons plus 1 : 1 counseling, as necessary. CONCLUSION: This study indicates that a necessity exists for development of a sex education program for NKDWs to enhance their contraceptive knowledge. Thus, government and health managers have a role to play in developing such a program.

How far can African swine fever spread?

African Swine Fever (ASF) is a highly contagious and deadly viral disease affecting both domestic pig and wild boar populations. Once introduced, it is a terrible disease that can devastate the swine industry in many countries. ASF has spread most recently beyond China to Southeast Asia, and parts of the Korean Peninsula. The majority of Asian countries consume pork as the primary source of meat compared to all other meat products. Particular emphasis is on the spread of ASF within North Korea and on future perspectives including protective guidelines. Thus far, the Korean peninsula has endured an extensive history of diseases, most notably from foot and mouth disease. For this reason, the Korean swine industries are familiar with the detrimental impacts of such a disease. On the other hand, exposure to a disease like ASF will decimate the swine industry even further. Therefore, it is crucial to bring urgent awareness to the spread of ASF.

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

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

Association of Traumatic Events, Post Traumatic Stress Disorder and Sexual Autonomy among Female University Students of North Korean Defectors / 여성건강간호학회지

PURPOSE: To determine associations of traumatic events and post-traumatic stress disorder (PTSD) with sexual autonomy and identify factors influencing sexual autonomy among female university students of North Korean defectors. METHODS: A cross-sectional, descriptive study was performed with a total of 103 female students who completed a structured online self-report survey from January 7 to March 31, 2018. This study was conducted using questionnaires on interpersonal trauma scale, the Traumatic Scale for North Korean Refugees (TSNKR), and sexual autonomy measurement for college students. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson's correlation coefficients, and multiple linear regression with SPSS WIN 23.0 program. RESULTS: Traumatic events, PTSD, and sexual autonomy scores were 3.96±3.07, 31.47±10.75, and 52.66±6.89, respectively. PTSD was positively correlated with traumatic events (r=.22, p=.030). Sexual autonomy was inversely correlated with PTSD (r=−.25, p=.010). Contraceptive use, PTSD, and voluntary sexual debut explained 26% of sexual autonomy of participants. CONCLUSION: To improve sexual autonomy of young women from North Korea, reproductive intervention programs including contraception, sexual assertiveness training, and psychoeducation to reduce PTSD need to be developed and implemented.

Subcutaneous Sparganosis on Abdomen Mimicking Multiple Lipomas

Human sparganosis is a food-borne zoonosis mainly caused by the plerocercoid belonging to the genus Spirometra. The most common clinical sign of sparganosis is a subcutaneous mass in the trunk including abdominal or chest wall. The mass may be mistaken for a malignant tumor, thereby causing difficulty in terms of diagnosis and treatment. A 66-year-old woman visited our clinic for the removal of a lipoma-like mass. It was movable, hard, and painless. We identified 2 white mass, measuring 0.2×4 cm and 0.2×1 cm. Pathologic findings indicated the white mass was a sparganum. She recalled having eaten a raw frog approximately 60 years before. A 35-year-old who lived North Korea was also presented to our clinic with an asymptomatic nodule on her abdomen. Intraoperatively, we found sparganum approximately 24 cm size. Subcutaneous masses are associated with clinical signs of inflammation or they may mimic a soft tissue neoplasm. While the incidence rate of sparganosis has decreased with economic development and advancements in sanitation, surgeons still encounter patients with sparganosis in the clinical setting. Therefore, a careful history is required in order to diagnose sparganosis.

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.

The Significance and Limits of Lee Quede's Anatomical Drawings / 체질인류학회지

In 1951, in the midst of the Korean War, artist Lee Quede produced anatomical drawings to teach artistic anatomy to his student Lee Ju-yeong while interned in the Geoje prison camp. Comprising 2 books and spanning over 48 pages, 74 drawings were produced alongside explanations in a textbook format. The table of contents was ordered starting from body proportions, then the skeleton, the muscles, and the head. By part, there were 4 drawings of the trunk, 51 of the head, 7 of the arms, 9 of the legs, and 3 of the full body. Though the drawings of the head and face are both high in number and in detail, there were many errors in his depictions of the bones, and the boundaries between the structures of his muscle drawings were drawn so unclearly as to be indistinguishable. The essential forms, proportions and movement are included, but his disproportionate dedication to the head and the incoherent way that the book is arranged with no relevance to its table of contents leave something to be desired. It is regrettable that Lee Quede's return to North Korea meant that his drawings were not widely used, but despite this, I believe that these are invaluable documents in assessing the influence of Japanese artistic anatomy at the time, as well as the introductory circumstances of Korean artistic anatomy.

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

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

Delphi study to achieve consensus for the development strategies of emergency medical services system preparing for reunification of Korea

OBJECTIVE: This study aimed to achieve expert consensus for the development of strategies emergency medical services system (EMSS) after reunification of Korean using the Delphi method. METHODS: The Delphi study was performed through several rounds from January to February in 2017. Experts who have experiences of emergency medical support in North Korea and developing countries participated in the study. Respondents were asked to express their level of agreement following 7 categories: (1) emergency medical manpower, (2) communication system, (3) emergency facilities, (4) patient transfer system, (5) consumer participation and public education, (6) insurance system, (7) disaster planning. Score 1–3 was classified as disagreement, 4–6 as medium agreement, and 7–9 as agreement and consensus was considered being achieved when more than two thirds of respondents agreed in each question. RESULTS: Response rate were 80% in the first round and 75% in the second round. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, and disaster planning for the important factors immediately after reunification within 5 years. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, consumer participation and public education, and disaster planning for the prior factors when the reunification would happen rapidly without enough preparation. CONCLUSION: Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, disaster planning for the essential EMSS elements. The consensus was expected to utilize as a basic data for the development of EMSS preparing for reunification.

An Analysis of Infectious Disease Research Trends in Medical Journals From North Korea / 예방의학회지

OBJECTIVES: This study aimed to investigate the current status of infectious disease research in North Korea by analyzing recent trends in medical journals from North Korea in comparison with research from South Korea. METHODS: Three medical journals (Preventive Medicine, Basic Medicine, and Chosun Medicine) were analyzed from 2012 to 2016. Articles on tuberculosis (TB), malaria, and parasitic diseases were selected and classified by their subtopics and study areas. Two medical journals published in the South Korea were selected for a comparative analysis of research trends. RESULTS: Of the 2792 articles that were reviewed, 93 were extracted from North Korea journals. TB research in North Korea was largely focused on multi-drug resistant TB and extrapulmonary TB, whereas research in South Korea more frequently investigated non-tuberculous mycobacteria. Research on parasitic diseases in North Korea was focused on protozoan and intestinal nematodes, while the corresponding South Korea research investigated various species of parasites. Additionally, the studies conducted in North Korea were more likely to investigate the application of traditional medicine to diagnosis and treatment than those conducted in South Korea. CONCLUSIONS: This study presents an analysis of research trends in preventive medicine in North Korea focusing on infectious diseases, in which clear differences were observed between South and North Korea. Trends in research topics suggest a high prevalence of certain parasitic diseases in North Korea that are no longer widespread in South Korea. The large proportion of studies examining traditional medicine implies a lack of affordable medicine in North Korea.

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

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