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

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

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

Phaenomenological Combustion Modeling of Medium-Speed Micro-Pilot Ignited Dual-Fuel Engine

Climate change pushes the decarbonization of international shipping. Though many technologies have been proposed, the most feasible way is to operate engines with low-carbon fuels. DF (Dual-Fuel) engines have become popular since it allows a flexible choice between diesel and gas fuels. The combustion of this engine in gas mode is a highly complex process showing both autoignition and premixed combustion. Thus, the phenomenological combustion model of the DF engine is developed in this study to be used for further understanding of DF combustion and improvement of DF engine. This work is composed of three parts. First, the empirical DF combustion model is developed employing a double Vibe function based on the test data from H35DF medium-speed engine. Furthermore, it is utilized to understand the DF combustion characteristics and effects of main engine parameters on DF combustion. Second, micro-pilot spray and ignition in the DF engine are investigated. The 1D transient spray model is developed to capture the behavior of the MP (Micro-Pilot) spray, longer ignition delay than injection duration, with particular attention. The MP ignition model is developed in two ways: the spray edge tracking and the 0D transient flamelet approach. The models are validated using various test data from ECN (Engine Combustion Network) Spray A, ETH RCEM (Rapid Compression and Expansion Machine), and the industrial H35DF engine for marine application. Finally, a phenomenological DF combustion model for the medium-speed DF engine is developed. The three-zone approach is employed to model the combustion based on the investigation through the 3D CFD. Arrhenius-like reaction rate model is used in the pilot zone, and flame propagation model combined with chemical time scale model is used in the main unburned zone with the help of MP spray and ignition model. The model is validated using the test data from the H35DF engine and shows reasonable accuracy. The combustion model developed in this work can be used as a fast and reliable tool for DF engine development. It can be implemented into the 1D engine system simulation to predict the engine performance for the relatively wider engine operating conditions and higher accuracy

Modified S2CVA Algorithm Using Cross-Sharpened Images for Unsupervised Change Detection

This study aims to reduce the false alarm rate due to relief displacement and seasonal effects of high-spatial-resolution multitemporal satellite images in change detection algorithms. Cross-sharpened images were used to increase the accuracy of unsupervised change detection results. A cross-sharpened image is defined as a combination of synthetically pan-sharpened images obtained from the pan-sharpening of multitemporal images (two panchromatic and two multispectral images) acquired before and after the change. A total of four cross-sharpened images were generated and used in combination for change detection. Sequential spectral change vector analysis (S2CVA), which comprises the magnitude and direction information of the difference image of the multitemporal images, was applied to minimize the false alarm rate using cross-sharpened images. Specifically, the direction information of S2CVA was used to minimize the false alarm rate when applying S2CVA algorithms to cross-sharpened images. We improved the change detection accuracy by integrating the magnitude and direction information obtained using S2CVA for the cross-sharpened images. In the experiment using KOMPSAT-2 satellite imagery, the false alarm rate of the change detection results decreased with the use of cross-sharpened images compared to that with the use of only the magnitude information from the original S2CVA

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