SOCIAL SUPPORT AND WELL-BEING OF SOUTH KOREANS AND NORTH KOREAN REFUGEES IN SOUTH KOREA

Approximately 33,000 North Korean refugees (NKRs) resettled in South Korea during the last 25 years. NKRs form social networks with other NKRs and South Koreans (SKs), but many struggle to adapt to South Korea. The overall objective of this dissertation is to understand the influences of support exchange on the well-being of SK (host population) and NKR adults (migrants). Between September and December 2019, semi-structured interviews were conducted with 30 NKRs and 20 SKs who were friends or acquaintances of NKRs. A Grounded Theory approach was used for data analysis. To complement the qualitative findings about support in SKs, we also used a nationally representative cross-sectional survey. We first examined the influence of social support on the well-being of SKs (Chapter 4). Qualitative findings indicated that support exchange appeared to be related to well-being. SKs perceived individualism to be a negative attribute fostering indifference to others. Quantitative findings suggested that prioritization of individual benefits over benefits for the community was inversely related to high subjective well-being. The perceived availability of financial support was associated with high levels of well-being among middle-aged and older adults. Next, we explored coping strategies NKRs adopted to reduce acculturative stress (Chapter 5). Findings suggested that NKRs primarily sought support from culturally similar groups. Some SKs tried to develop family-like relationships with NKRs. NKRs who were enthusiastic about assimilating into South Korean society strategically approached SKs to learn about their culture. To cope with acculturative stress, NKRs developed different coping strategies, depending on whether the social network members were NKRs, Korean Chinese or SKs. Further, we found that reciprocity was critical for the well-being of NKRs (Chapter 6). While NKRs practiced bidirectional support exchange prior to resettlement, support exchange became unidirectional in South Korea, which created uncomfortable feelings among some NKRs. However, NKRs who desired to reciprocate reported high levels of well-being. Together, these findings highlight that the promotion of social support among SKs has the capacity to enhance well-being. Moreover, support exchange within one’s social network may be essential for improving the well-being of NKRs, underscoring the need for efforts to facilitate NKRs’ social relationships

Measuring the Needs for Medical Service in the Retirement Residential Community in Korea

Medical facilities in retirement residential areas provide diverse medical and health-related services to retirees, and they are equipped and programed with various medical services for enhancing retirees’ daily activities. To find out the current status of using medical facilities by retirees, this study surveyed retirees in their fifties, sixties, and seventies, who live in Eunpyeong-gu, Seoul. The survey data was sorted by the types of medical facilities they visit, reasons for their visit, and the types of medical facilities in a retirement residential area they would prefer to visit. The pros and cons of using private and general hospitals can be evaluated further to set up the right strategy to reconcile them; and each type of hospital can be improved by adding those missing elements that the interviewees mentioned. In the broad perspective, this indicates the need to suggest the direction of preparing residential areas that are technically planned for retirees on the basis of the analysis of Korean retirees’ needs

Family concerns and relationship problems in anxious pregnant women and their associations with postnatal functional disability in Pakistan.

ObjectiveExpanding on existing research suggesting that strategies to reduce prenatal anxiety can decrease functional disability (e.g., difficulties in performing everyday activities and social participation), we examined if this effect varied by type of anxiety-producing problem (i.e., having family concerns and relationship problems versus other problems) reported during pregnancy. Further, we explored if perceived social support mediated this relationship.MethodsWe used longitudinal data on 310 anxious Pakistani women who received any psychosocial intervention sessions as part of a program that was based on Cognitive Behavioral Therapy. The Psychological Outcome Profiles (PSYCHLOPS) was used to assess whether women had 'family concerns and relationship problems' or 'other problems.' The WHO Disability Assessment Schedule 2.0 assessed functional disability at six-weeks after delivery. Lack of support was measured using a 12-item Multi-dimensional Scale of Perceived Social Support. We employed linear regression to examine associations between types of problems reported during pregnancy and postnatal functional disability. Causal mediation analysis was used to assess whether postnatal social support mediated this relationship.ResultsOf anxious pregnant women, 34% reported family concerns or relationship problems as primary problems in pregnancy. They were more likely to report higher functional disability at six-weeks after delivery than women who reported other problems (adjusted B = 2.40, 95% CI: 0.83-3.97). Lack of overall social support (Estimateindirect = 0.69, 95% CI: 0.04-1.38) and lack of support from friends (Estimateindirect = 0.62, 95% CI: 0.01-1.29) significantly mediated the relationship.ConclusionsFindings suggest that complementing pre- and post-natal care with support programs and services that address family concerns and relationship problems, as well as enhancing social support is important to functional disability

Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive-behavioural therapy (CBT) intervention.

BackgroundLittle is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety.AimsWe investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive-behavioural therapy (CBT) had a regulatory effect.MethodsParticipants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.ResultsHassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=-0.82, 95% CI: -1.46 to -0.18) and anxiety (B=-0.70, 95% CI: -1.25 to -0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.ConclusionsStressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences.Trial registration numberNCT03880032

Social Support and Spousal Relationship Quality Improves Responsiveness among Anxious Mothers.

Maternal responsiveness, a mother's ability to consistently identify infant cues and then act on them, is critical for healthy child development. A woman's social support and spousal relationship may affect responsiveness to an infant, especially among mothers with anxiety. We assessed how social support and spousal relationship quality is associated with responsiveness among anxious mothers, and if postpartum depression (PPD) moderated these associations. Cross-sectional data were collected from 2019 to 2022 in a public hospital in Pakistan from 701 women at six-weeks postpartum. Eligible women had at least mild anxiety in early- to mid- pregnancy. Linear regression analyses assessed if spousal relationship quality and social support from family and friends were associated with maternal responsiveness, measured using the Maternal Infant Responsiveness Instrument. Interaction terms were used to examine if PPD moderated these associations. Spousal relationship quality (B = 2.49, 95% CI: 1.48, 3.50) and social support (B = 1.07, 95% CI: 0.31, 1.83) were positively related to maternal responsiveness to the infant. Emotional support from a spouse was positively associated with responsiveness (B = 1.08, 95% CI: 0.12, 2.03 depressed; B = 2.96, 95% CI: 1.34, 4.58 non-depressed), and conflict with the spouse was negatively associated with responsiveness (B=-1.02, 95% CI: -1.94, -0.09 depressed; B=-2.87, 95% CI: -4.36, -1.37 non-depressed). However, social support was related to responsiveness only in non-depressed women (B = 2.61, 95% CI: 1.14, 4.07). While spousal relationships and social support enhance maternal responsiveness, for depressed women, spousal relationships were particularly critical. In considering maternal-infant interventions to improve child development outcomes, our study indicates the importance of supportive relationships that foster effective responsiveness

Breast Cancer Diagnosis Using a Microfluidic Multiplexed Immunohistochemistry Platform

BACKGROUND: Biomarkers play a key role in risk assessment, assessing treatment response, and detecting recurrence and the investigation of multiple biomarkers may also prove useful in accurate prediction and prognosis of cancers. Immunohistochemistry (IHC) has been a major diagnostic tool to identify therapeutic biomarkers and to subclassify breast cancer patients. However, there is no suitable IHC platform for multiplex assay toward personalized cancer therapy. Here, we report a microfluidics-based multiplexed IHC (MMIHC) platform that significantly improves IHC performance in reduction of time and tissue consumption, quantification, consistency, sensitivity, specificity and cost-effectiveness. METHODOLOGY/PRINCIPAL FINDINGS: By creating a simple and robust interface between the device and human breast tissue samples, we not only applied conventional thin-section tissues into on-chip without any additional modification process, but also attained perfect fluid control for various solutions, without any leakage, bubble formation, or cross-contamination. Four biomarkers, estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2), progesterone receptor (PR) and Ki-67, were examined simultaneously on breast cancer cells and human breast cancer tissues. The MMIHC method improved immunoreaction, reducing time and reagent consumption. Moreover, it showed the availability of semi-quantitative analysis by comparing Western blot. Concordance study proved strong consensus between conventional whole-section analysis and MMIHC (n = 105, lowest Kendall's coefficient of concordance, 0.90). To demonstrate the suitability of MMIHC for scarce samples, it was also applied successfully to tissues from needle biopsies. CONCLUSIONS/SIGNIFICANCE: The microfluidic system, for the first time, was successfully applied to human clinical tissue samples and histopathological diagnosis was realized for breast cancers. Our results showing substantial agreement indicate that several cancer-related proteins can be simultaneously investigated on a single tumor section, giving clear advantages and technical advances over standard immunohistochemical method. This novel concept will enable histopathological diagnosis using numerous specific biomarkers at a time even for small-sized specimens, thus facilitating the individualization of cancer therapy

Effects of a prenatal anxiety randomized controlled trial intervention on infant development in Pakistan.

ObjectivesGiven that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship.MethodsBetween 2020 and 2022, pregnant women participated in a randomized controlled trial of the Happy Mother-Healthy Baby (HMHB) program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators.ResultsSocio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI:-0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (Bindirect=1.94 (95%CI: 0.86, 3.25) depression; Bindirect=0.57 (95% CI: 0.09, 1.16) bonding; Bindirect=0.53 (95% CI: 0.01, 1.21) responsiveness; and Bindirect=1.94 (95%CI: 0.86, 3.25). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively.ConclusionsHMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings.Trial registrationClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032

Perinatal Intimate Partner Violence and Maternal-Infant Bonding in Women With Anxiety Symptoms in Pakistan: The Moderating Role of Breastfeeding.

Intimate partner violence (IPV) during the perinatal period can negatively affect both a woman's health and the bonding with her infant. Research on IPV among pregnant women experiencing psychological distress in South Asia is limited. We examined associations between perinatal exposure to IPV and postnatal maternal-infant bonding in Pakistani women with symptoms of anxiety and assessed if breastfeeding practices moderated these associations. Postnatal data were collected from 720 Pakistani women who reported at least mild levels of anxiety symptoms in pregnancy. We performed Poisson regression with robust variance analyses to examine the associations between IPV during pregnancy or within 6 weeks after delivery (i.e., the perinatal period) and maternal-infant bonding. Interaction terms between IPV and breastfeeding practices were included in the analytic models to examine the moderating effects. About 27% of women were exposed to at least one type of perinatal IPV. Women who were exposed to IPV were more likely to have moderate to severe postpartum anxiety (n = 57, 28.9% of IPV-exposed women), compared to those without IPV (n = 65, 12.4% of unexposed women; p value < .001). Compared to women not reporting IPV, women exposed to any IPV showed a 38% increase in Postpartum Bonding Questionnaire scores, suggesting higher likelihood of impaired bonding (risk ratio [RR] = 1.38, 95% confidence interval [CI] [1.21, 1.56]). Among women who initiated breastfeeding later than 1 hr post-delivery, IPV was associated with impaired bonding (RR = 1.09, 95% CI [1.06, 1.20]), whereas no association was present for women who initiated breastfeeding within 1 hr (RR = 1.03, 95% CI [0.98, 1.08]). In addition to the efforts to reduce IPV, encouraging IPV-exposed women to adhere to the breastfeeding guidelines (e.g., early breastfeeding) may enhance maternal-infant bonding

Improving Urban Retirees’ Well-Being by Leisure Activities

This research is to investigate urban retirees’ needs and suggest the design direction of leisure facilities. Unlike the existing approach based on deterioration of physical ability, this will allow a new type of suggestion to enable the retirees to live their second lives in a more creative way. By analyzing their common memories and events, it was found that they developed their desire for leisure from their experience of wealth and economic growths. Some preceding research pointed out that their actual leisure activities tend to be static and passive in general. Through the interview, however, this research has found that there are 45 indoor activities and 75 outdoor leisure activities, while their potential demands for leisure further extends to 88. With outdoor activities outnumbering indoor activities, the result shows the opposite tendency to the preceding research. On the other hand, their potential demands for leisure further extended to include more intellectually stimulating learning activities

Types of social capital in relation to self-rated health: Gender differences in a nationally representative cross-sectional study of South Korean adults

Socio-economic and cultural transformations in South Korea have led to societal heterogeneity, potentially changing the role of social capital. We examined whether six factors (i.e. group membership, out-group trust, civic responsibility, acceptance, political activism, and institutional trust) that represent bonding, bridging, and linking social capital are associated with self-rated health (SRH), and whether these associations vary by gender. We analysed data from 8,000 adults in the Korea Social Integration Survey. We first conducted exploratory and confirmatory analyses to create and verify a social capital scale. Then, we performed multivariable logistic regression analyses to study how each type of social capital was related to SRH, adjusting for survey design and sampling weights. High levels of group membership and civic responsibility were associated with good SRH among men only, while high levels of out-group trust, acceptance, and institutional trust were associated with good SRH only for women. High levels of political activism were negatively related to good SRH for both men and women. Overall, associations between different types of social capital and SRH differed by gender in the South Korean context; thus, men and women may benefit from health interventions that enhance different forms of social capital