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Abstract This retrospective study investigated the degree of intraocular lens (IOL) tilt and decentration after cataract surgery in eyes with varying degrees of myopia using the anterior segment optical coherence tomography (AS-OCT). Eyes of 76 patients were analyzed and divided into three groups: mild myopia (emmetropia to − 1.5 diopter [D], Group 1), moderate myopia (− 1.5 D to − 6.0 D, Group 2), and high myopia (over − 6.0 D, Group 3). Postoperative IOL decentration, tilt, and lens diameter were evaluated using swept-source AS-OCT under mesopic conditions without dilation eyedrop. Postoperative parameters revealed no difference in IOL tilt, but IOL decentration was significantly different among the groups, and the degree of decentration was greater in Group 3 (P = 0.007). Univariable regression analysis indicated that age, sex, preoperative uncorrected distant visual acuity, corrected distant visual acuity, intraocular pressure, spherical equivalent, preoperative anterior chamber depth and lens thickness had no influence on postoperative IOL decentration, but axial length (AL) was significantly related to IOL decentration (P = 0.001). This association was confirmed using multivariable regression analysis, establishing a significant correlation between AL and IOL decentration (P = 0.001) on AS-OCT, showing an increase in IOL decentration associated with increasing AL.

Abstract Background To investigate the outcomes of bilateral implantation of enhanced monofocal intraocular lenses (IOLs, ICB00) with a − 2.00 diopter (D) target in patients with moderate to high myopia and to compare the clinical outcomes of a − 2.00 D binocular target with an emmetropia target in patients who underwent cataract surgery. Methods In this retrospective study, we reviewed the medical records of patients who underwent uncomplicated phacoemulsification with ICB00 IOL implantation. Emmetropia (Group 1) and − 2.00 D (Group 2) were targeted in 60 and 20 eyes of 30 and 10 patients, respectively. Three months after surgery, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA) were measured. Defocus curves were measured under the photopic condition by intervals of 0.50 D from + 0.50 D to − 4.00 D. Results The postoperative binocular logMAR UDVA, UIVA, and UNVA were 0.01 ± 0.03, 0.08 ± 0.11, and 0.33 ± 0.15 in Group 1 and 0.31 ± 0.13, 0.04 ± 0.05, and 0.11 ± 0.07 in Group 2, respectively. Group 2 showed a significantly superior postoperative binocular UNVA (P = 0.027) and inferior binocular UDVA (P = 0.003) than Group 1. Binocular UIVA and CDVA did not significantly differ between the groups although UIVA was better in Group 2 than in Group 1. Near glasses were needed by 66% of Group 1 and 0% of Group 2. Conclusions Bilateral implantation of ICB00 IOL with − 2.00 D of residual myopia is suitable for patients with moderate to high myopia to improve UDVA, UIVA, and UNVA.

Abstract Purpose To compare long-term intraocular lens (IOL) decentration and tilt following femtosecond laser-assisted cataract surgery (FLACS) and conventional surgery using swept-source anterior segment ocular coherence tomography (SS-ASOCT). Methods In this retrospective cross-sectional study, all patients underwent FLACS or conventional cataract surgery. Those with a minimum of 12-months follow-up since surgery were included. Patients with surgical complications were excluded. Demographics, preoperative ocular measurements (axial length, anterior chamber depth), and postoperative measurements [corrected distance visual acuity (CDVA), autorefraction, keratometry, IOL type] were collected. Postoperative IOL tilt and decentration were compared using SS-ASOCT between patients with FLACS and conventional cataract surgery. Subgroup analysis was conducted to analyze tilt and decentration by haptic type (single-piece vs. three-piece). Results A total of 188 eyes were included [110 (58.5%) in the FLACS group and 78 (41.5%) in the conventional group]. No differences were observed between the FLACS and conventional groups regarding preoperative parameters. FLACS resulted in less IOL decentration compared to conventional cataract surgery (170 μm vs. 240 μm, p = 0.002). No statistically significant differences were observed between the FLACS and conventional groups in the magnitude and axis of IOL tilt. Both groups had a trend of IOL tilt toward the inferotemporal aspects. Moreover, no difference regarding postoperative CDVA, spherical equivalent, and keratometric astigmatism was observed. Conclusions FLACS resulted in significantly better long-term IOL centration than conventional surgery with manual capsulotomy. No significant difference in IOL tilt or postoperative CDVA was observed between FLACS and conventional cataract surgery.

Background: This study aimed to identify the prevalence of workplace hazards and organizational protection resources according to the size of the enterprise in the manufacturing industry of the Republic of Korea. Methods: We analyzed data of waged workers (weighted N = 5,879) from the Fifth Korean Working Conditions Survey (2017). Enterprise sizes were categorized as “micro enterprises” (less than five employees), “small enterprises” (5–49 employees) and “medium-large enterprises” (50 or more employees). Self-reported exposure to 18 physical, chemical, ergonomic, and psychological hazards were measured. The presence of organizational protection resources such as a labor union, a safety delegate working at the company, designated spaces to deal with safety, and the provision of health and safety information was evaluated. Results: Compared to workers in medium-large enterprises, those in micro enterprises showed a higher proportion of exposure to most of physical, chemical, ergonomic, and psychological hazards, except for exposure to solvents, prolonged sitting, and experiencing a state of emotional unrest. On the other hand, workers in micro enterprises had the lowest proportion of access to organizational protection resources. Conclusion: Our study demonstrates that manufacturing workers at the micro enterprise in the Republic of Korea are exposed to the most hazardous work environment and yet have access to the fewest organizational protection resources.

Abstract Background In South Korea, Korean Chinese workers experience ethnic discrimination although they share physical similarities and ethnic heritage with native-born Koreans. This study aimed to examine whether perceived ethnic discrimination is associated with poor self-rated health and whether the association differs by gender among Korean Chinese waged workers in South Korea. Methods We conducted a pooled cross-sectional analysis using data of 13,443 Korean Chinese waged workers from the Survey on Immigrants’ Living Conditions and Labor Force conducted in 2018, 2020, and 2022. Based on perceived ethnic discrimination, asking for fair treatment, and subsequent situational improvement, respondents were classified into the following four groups: “Not experienced,” “Experienced, not asked for fair treatment,” “Experienced, asked for fair treatment, not improved,” and “Experienced, asked for fair treatment, improved.” Poor self-rated health was assessed using a single question “How is your current overall health?” We applied logistic regression to examine the association between perceived ethnic discrimination and poor self-rated health, with gender-stratified analyses. Results We found an association between ethnic discrimination and poor self-rated health among Korean Chinese waged workers. In the gender-stratified analysis, the “Experienced, not asked for fair treatment” group was more likely to report poor self-rated health compared to the “Not experienced” group, regardless of gender. However, gender differences were observed in the group stratified by situational improvements. For male workers, no statistically significant association was found in the “Experienced, asked for fair treatment, improved” group with poor self-rated health (odd ratios: 0.87, 95% confidence intervals: 0.30–2.53). Conversely, among female workers, a statistically significant association was observed (odd ratios: 2.63, 95% confidence intervals: 1.29–5.38). Conclusions This study is the first to find an association between perceived ethnic discrimination and poor self-rated health, along with gender differences in the association between situational improvements after asking for fair treatment and poor self-rated health among Korean Chinese waged workers in South Korea.

IntroductionWith a growing aging population, the focus on the health and well-being of older adults, especially in preventing falls, becomes crucial. This 3 month study, initiated in July 2022, aimed to assess the impact of a nutrition and exercise program in senior daycare centers in Chuncheon, South Korea.MethodsA 3 month study, beginning in July 2022, included 204 older adults from 10 senior daycare centers in Chuncheon, South Korea. Randomly assigned to intervention or control groups, the intervention involved nutrition, daily toe exercises, or both. Control centers received interventions post-measurements. Pre- and post-intervention analyses used paired t-tests and multiple linear regression, assessing metrics like toe grip strength for significance. While 204 were initially enrolled, the analysis included 151 participants due to dropouts.ResultsParticipants, with a mean age of 83.3 years (43.1% aged ≥ 85 years), exhibited mild to moderate cognitive impairment and multiple chronic illnesses. Health data indicated that 37.3% were obese, and the average BMI was 24.0 kg/m2. Both the intervention and control groups showed significant improvements in toe grip strength post-intervention. Specifically, the exercise-only and combined exercise-nutrition groups demonstrated significant differences in hallux strength compared to the control group after adjusting for age and gender.ConclusionThe study showed that a basic nutrition and exercise program increased toe strength in older adults with chronic diseases, including mild cognitive impairments. This intervention holds potential to prevent muscle strength decline and reduce fall risks in older individuals. As the first of its kind in Korean senior daycare centers, it emphasizes the need for future research and standardized programs for senior daycare users.

Scan chains are essential for enhancing the testability of semiconductor circuits. While scan chains enhance the testing capability, defects can also occur in scan chains due to the hardware overhead caused by scan chains. To prevent a decrease in yield due to such defects, scan chain diagnosis is widely used in semiconductor manufacturing as an important system. Particularly, with the increasing complexity of semiconductor circuits, there is a growing necessity for the diagnosis of intermittent faults. Since the distinct patterns are shown in test results for intermittent faults compared to permanent faults, a decrease in diagnostic accuracy is caused by the occurrence of intermittent faults. To address this problem, this paper introduces a new deep-learning-based scan-chain diagnosis method, designed to diagnose both intermittent and permanent faults. The proposed method introduces two new concepts for diagnosing not only permanent but also intermittent faults. One is a CNN optimized for scan chain diagnosis, and the other is newly optimized input data tailored for this CNN architecture. The proposed CNN architecture is composed of multiple layers centered around the modified inception module adapted for scan chain diagnosis, maintaining spatial and local information while enabling additional feature extraction. Furthermore, the new input data is multi-channel data composed of subset failure vectors (SFVs), integer failure vectors (IFVs), and fan-out vectors, allowing for the maximization of CNN characteristics. The experimental results demonstrate that diagnostic accuracy for intermittent faults is significantly improved by the proposed method compared to previous works.

Iris segmentation is an initial step for identifying the biometrics of animals when establishing a traceability system for livestock. In this study, we propose a deep learning framework for pixel-wise segmentation of bovine iris with a minimized use of annotation labels utilizing the BovineAAEyes80 public dataset. The proposed image segmentation framework encompasses data collection, data preparation, data augmentation selection, training of 15 deep neural network (DNN) models with varying encoder backbones and segmentation decoder DNNs, and evaluation of the models using multiple metrics and graphical segmentation results. This framework aims to provide comprehensive and in-depth information on each model’s training and testing outcomes to optimize bovine iris segmentation performance. In the experiment, U-Net with a VGG16 backbone was identified as the optimal combination of encoder and decoder models for the dataset, achieving an accuracy and dice coefficient score of 99.50% and 98.35%, respectively. Notably, the selected model accurately segmented even corrupted images without proper annotation data. This study contributes to the advancement of iris segmentation and the establishment of a reliable DNN training framework.

Abstract Humans express their emotions in various ways, such as through facial expressions and voices. In particular, emotions are directly expressed or indirectly implied in the text of utterance. Research on the technology to identify emotions included in human speech and generate utterances is being conducted in conversational artificial intelligence technology. Despite the importance of recognizing the factors of previously generated emotions to generate emotion-based utterances, most of the existing datasets only provide the classification of emotions in text and utterances. In addition, in the case of Korean datasets, the classification of emotions is not diverse, and it is mainly biased toward negative emotion classification. In this paper, we propose KEmoFact, a Korean emotion-factor dataset for extracting emotion and factors in Korean conversations. We also define two tasks for the KEmoFact dataset, EFE (Emotion Factor Extraction) and EFPE (Emotion-Factor Pair Extraction), and propose baseline models for the tasks. We contribute to the study of conversational artificial intelligence, especially in Korean, one of the low-resource languages, by proposing the KEmoFact dataset and suggesting baseline models for two tasks.

The accurate diagnosis and effective treatment of mental health disorders such as depression remain challenging owing to the complex underlying causes and varied symptomatology. Traditional information extraction methods struggle to adapt to evolving diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) and to contextualize rich patient data effectively. This study proposes a novel approach for enhancing information extraction from mental health data by integrating medical knowledge graphs and large language models (LLMs). Our method leverages the structured organization of knowledge graphs specifically designed for the rich domain of mental health, combined with the powerful predictive capabilities and zero-shot learning abilities of LLMs. This research enhances the quality of knowledge graphs through entity linking and demonstrates superiority over traditional information extraction techniques, making a significant contribution to the field of mental health. It enables a more fine-grained analysis of the data and the development of new applications. Our approach redefines the manner in which mental health data are extracted and utilized. By integrating these insights with existing healthcare applications, the groundwork is laid for the development of real-time patient monitoring systems. The performance evaluation of this knowledge graph highlights its effectiveness and reliability, indicating significant advancements in automating medical data processing and depression management.

Abstract We developed a machine learning algorithm (MLA) that can classify human thyroid cell clusters by exploiting both Papanicolaou staining and intrinsic refractive index (RI) as correlative imaging contrasts and evaluated the effects of this combination on diagnostic performance. Thyroid fine-needle aspiration biopsy (FNAB) specimens were analyzed using correlative optical diffraction tomography, which can simultaneously measure both, the color brightfield of Papanicolaou staining and three-dimensional RI distribution. The MLA was designed to classify benign and malignant cell clusters using color images, RI images, or both. We included 1535 thyroid cell clusters (benign: malignancy = 1128:407) from 124 patients. Accuracies of MLA classifiers using color images, RI images, and both were 98.0%, 98.0%, and 100%, respectively. As information for classification, the nucleus size was mainly used in the color image; however, detailed morphological information of the nucleus was also used in the RI image. We demonstrate that the present MLA and correlative FNAB imaging approach has the potential for diagnosing thyroid cancer, and complementary information from color and RI images can improve the performance of the MLA.

Abstract We investigated differences in brain activity in response to sleep-related pictures between chronic insomnia disorder (CID) patients and good sleepers (GS), and examined whether brain activity moderated the relationship between depressive symptoms and sleep disturbance in CID patients and GS. This study included 43 patients diagnosed with CID, based on the International Classification of Sleep Disorders-3, and 42 GS. The participants kept a sleep diary, underwent nocturnal polysomnography to measure sleep parameters, and completed self-report questionnaires to assess sleep and psychiatric symptoms. They underwent functional magnetic resonance imaging (fMRI) to examine differences in brain activity in response to sleep-related pictures compared to neutral pictures. A moderated moderation analysis was performed to investigate the moderating role of brain responses to sleep-related pictures in the association between depressive symptoms and sleep disturbance. Compared to GS, the brain responses to sleep-related stimuli were significantly lower in CID patients in the right lateral prefrontal cortex (LPFC) and dorsomedial prefrontal cortex (DMPFC). More severe depressive symptoms were significantly associated with longer sleep latency only when LPFC activity was low in CID patients, but not in GS. LPFC hypoactivity in response to sleep-related stimuli in CID patients could moderate the relationship between depression and sleep disturbance.

Background and Objectives: The analgesia/nociception index (ANI) potentially monitors nociceptive status during anesthesia, but its link to preoperative pain sensitivity is unclear. We investigated the relationship between pre-anesthetic ANI scores and propofol injection pain (PIP) in patients receiving remifentanil. Materials and Methods: This study included 124 male patients aged 19–60 undergoing general anesthesia (ASA class I or II). Patients were randomized to group R (n = 62, remifentanil 4 ng/mL) or group C (n = 62, saline). The primary outcome was the association between PIP and ANI. Secondary outcomes included the incidence and severity of PIP or rocuronium-induced withdrawal movement (RIWM) and their association with ANI. Results: PIP and RIWM incidence and severity were lower in group R than in group C. A weak negative correlation between PIP and ANI at pre-induction (rpb = −0.21, p = 0.02, rpb = −0.37, p < 0.01) and a moderate negative correlation during propofol injection (rpb = −0.48, p = 0.02) were observed. A significant negative correlation was found between RIWM and ANI during rocuronium injection (τb = −0.61, p < 0.01). AUC, cut-off value, specificity, and sensitivity in ANI at pre-induction for predicting PIP were 0.67 (p = 0.02), 59, 76%, and 55%, respectively. AUC, cut-off value, specificity, and sensitivity in ANI during propofol injection for PIP were 0.77 (p < 0.01), 65, 81%, and 67%, respectively. Conclusions: ANI scores demonstrated significant differences between groups, suggesting potential predictive value for PIP despite the low pre-induction AUC value. This study highlights the potential of using ANI scores to predict and manage PIP in patients receiving remifentanil.

Background and Objectives: The effects of midazolam, a benzodiazepine, on pain perception are complex on both spinal and supraspinal levels. It is not yet known whether remimazolam clinically attenuates or worsens pain. The present study investigated the effect of intraoperative remimazolam on opioid-induced hyperalgesia (OIH) in patients undergoing general anesthesia. Materials and Methods: The patients were randomized into three groups: group RHR (6 mg/kg/h initial dose followed by 1 mg/kg/h remimazolam and 0.3 μg /kg/min remifentanil), group DHR (desflurane and 0.3 μg /kg/min remifentanil) or group DLR (desflurane and 0.05 µg/kg /min remifentanil). The primary outcome was a mechanical hyperalgesia threshold, while secondary outcomes included an area of hyperalgesia and clinically relevant pain outcomes. Results: Group RHR had a higher mechanical hyperalgesia threshold, a smaller hyperalgesia postoperative area at 24 h, a longer time to first rescue analgesia (p = 0.04), lower cumulative PCA volume containing morphine postoperatively consumed for 24 h (p < 0.01), and lower pain intensity for 12 h than group DHR (p < 0.001). However, there was no significant difference in OIH between groups RHR and DLR. Conclusions: Group RHR, which received remimazolam, attenuated OIH, including mechanically evoked pain and some clinically relevant pain outcomes caused by a high dose of remifentanil. Further research is essential to determine how clinically meaningful and important the small differences observed between the two groups are.

A wider array of color gamut and higher luminance are increasingly offered by displays to provide users with immersive content. However, in the latest displays available, it is difficult to predict image brightness because the extensively used color appearance model is made based on a color patch whose color appearance is not the same as that of an image on the display. Therefore, in this study, a method of predicting image brightness on a display depending on its color gamut by quantifying the Helmholtz–Kohlrausch (H–K) effect is proposed. A method for accurately measuring image luminance is also presented. To verify the performance of the proposed model, a brightness matching experiment is performed under two different color gamut sizes. The experimental results confirm that the image appears brighter with the increase in color gamut due to the H–K effect, demonstrating that the proposed prediction model exhibits desirable performance. The proposed brightness prediction model, which includes the image experience in the color range, delivers better image quality to users.

Background Numerous studies have noted the effect of chorda tympani (CT) nerve transection on taste sensitivity yet very few have directly observed its effects on taste receptor and taste signaling protein expressions in the tongue tissue. Methods In this study, bilateral CT nerve transection was performed in adult Sprague Dawley rats after establishing behavioral taste preference for sweet, bitter, and salty taste via short term two-bottle preference testing using a lickometer setup. Taste preference for all animals were subsequently monitored. The behavioral testing was paired with tissue sampling and protein expression analysis. Paired groups of CT nerve transected animals (CTX) and sham operated animals (SHAM) were sacrificed 7, 14, and 28 days post operation. Results Immunofluorescence staining of extracted tongue tissues shows that CT nerve transection resulted in micro-anatomical changes akin to previous investigations. Among the three taste qualities tested, only the preference for sweet taste was drastically affected. Subsequent results of the short-term two-bottle preference test indicated recovery of sweet taste preference over the course of 28 days. This recovery could possibly be due to maintenance of T1R3, GNAT3, and TRPM5 proteins allowing adaptable recovery of sweet taste preference despite down-regulation of both T1R2 and Sonic hedgehog proteins in CTX animals. This study is the first known attempt to correlate the disruption in taste preference with the altered expression of taste receptors and taste signaling proteins in the tongue brought about by CT nerve transection.

The analysis of AR is widely used to detect loss of acrosome in sperm, but the subjective decisions of experts affect the accuracy of the examination. Therefore, we develop an ARCS for objectivity and consistency of analysis using convolutional neural networks (CNNs) trained with various magnification images. Our models were trained on 215 microscopic images at 400× and 438 images at 1000× magnification using the ResNet 50 and Inception–ResNet v2 architectures. These models distinctly recognized micro-changes in the PM of AR sperms. Moreover, the Inception–ResNet v2-based ARCS achieved a mean average precision of over 97%. Our system’s calculation of the AR ratio on the test dataset produced results similar to the work of the three experts and could do so more quickly. Our model streamlines sperm detection and AR status determination using a CNN-based approach, replacing laborious tasks and expert assessments. The ARCS offers consistent AR sperm detection, reduced human error, and decreased working time. In conclusion, our study suggests the feasibility and benefits of using a sperm diagnosis artificial intelligence assistance system in routine practice scenarios.

Abstract We investigated the differential spatial covariance pattern of blood oxygen level-dependent (BOLD) responses to single-task and multitask functional magnetic resonance imaging (fMRI) between patients with psychophysiological insomnia (PI) and healthy controls (HCs), and evaluated features generated by principal component analysis (PCA) for discrimination of PI from HC, compared to features generated from BOLD responses to single-task fMRI using machine learning methods. In 19 patients with PI and 21 HCs, the mean beta value for each region of interest (ROIbval) was calculated with three contrast images (i.e., sleep-related picture, sleep-related sound, and Stroop stimuli). We performed discrimination analysis and compared with features generated from BOLD responses to single-task fMRI. We applied support vector machine analysis with a least absolute shrinkage and selection operator to evaluate five performance metrics: accuracy, recall, precision, specificity, and F2. Principal component features showed the best classification performance in all aspects of metrics compared to BOLD response to single-task fMRI. Bilateral inferior frontal gyrus (orbital), right calcarine cortex, right lingual gyrus, left inferior occipital gyrus, and left inferior temporal gyrus were identified as the most salient areas by feature selection. Our approach showed better performance in discriminating patients with PI from HCs, compared to single-task fMRI.

Abstract Delftia sp. K82 is a soil bacterium capable of utilizing monocyclic aromatic hydrocarbons, including aniline, as its sole carbon and nitrogen source. In this study, the genome analysis of Delftia sp. K82 was completed and the genome data (6117 protein-coding genes and 62 RNA genes) were utilized for proteomic and transcriptomic analysis of Delftia sp. K82 cultured in aniline culture medium. Using these multi-omics approaches (genomics, transcriptomics, and proteomics), complete gene clusters for aniline biodegradation pathways were identified and transcriptomic or proteomic sets specifically induced in aniline culture conditions were elucidated. These data provide multi-layered information on the metabolic characteristics of Delftia sp. K82. The findings suggest that multi-omics approaches are useful analytical tools for the elucidation of the metabolic diversity of soil bacteria and for the identification of novel metabolic enzymes.

Background Pneumococcal diseases among children aged 0.35 μg/mL was lower for some serotypes in the GBP411 group than in the comparator group (6B: 20.83% vs. 39.22%, P=0.047 and 19A: 58.33% vs. 90.20%, P97% of the subjects in each group achieved IgG concentrations of ≥0.35 μg/mL for all 12 serotypes. Increased immunogenicity was observed for some serotypes that showed significant intergroup differences after administration of the primary doses but not after the booster dose. We also found no significant intergroup difference in the overall incidence of solicited local adverse events. Furthermore, the overall incidence of solicited systemic adverse events was significantly lower in the GBP411 group than in the comparator vaccine group (79.59% vs. 98.04%; P=0.003). Conclusion The GBP411 vaccine with a dosing schedule of 2p+1 may be immunogenic and safe for healthy infants.

Abstract Background To gain insights into the socio-economic and political determinants of ill health and access to healthcare in North Korea. Methods A retrospective survey using respondent-driven sampling conducted in 2014–15 among 383 North Korean refugees newly resettling in South Korea, asking about experiences of illness and utilization of healthcare while in North Korea, analyzed according to measures of political, economic and human rights indicators. Results Although the Public Health Act claims that North Korea provides the comprehensive free care system, respondents reported high levels of unmet need and, among those obtaining care, widespread informal expenditure. Of the respondents, 55.1% (95%CI, 47.7–63.7%) had received healthcare for the most recent illness episode. High informal costs (53.8%, 95%CI, 45.1–60.8%) and a lack of medicines (39.5%, 95%CI, 33.3–47.1%) were reported as major healthcare barriers resulting in extensive self-medication with narcotic analgesics (53.7%, 95%CI, 45.7–61.2%). In multivariate logistic regressions, party membership was associated with better access to healthcare (Adjusted OR (AOR) = 2.34, 95%CI, 1.31–4.18), but household income (AOR = 0.40, 95%CI 0.21–0.78) and informal market activity (AOR = 0.29, 95%CIs 0.15–0.50) with reduced access. Respondents who could not enjoy political and economic rights were substantially more likely to report illness and extremely reduced access to care, even with life-threatening conditions. Conclusions There are large disparities in health and access to healthcare in North Korea, associated with political and economic inequalities. The scope to use these findings to bring about change is limited but they can inform international agencies and humanitarian organizations working in this unique setting.