Human viral pathogens in the wastewater-source water-drinking water continuum: Evidence, health risks, and lessons for future outbreaks in low-income settings.

Human viral pathogens, including SARS-CoV-2 continue to attract public and research attention due to their disruption of society, global health, and the economy. Several earlier reviews have investigated the occurrence and fate of SARS-CoV-2 in wastewater, and the potential to use such data in wastewater-based epidemiology. However, comprehensive reviews tracking SARS-CoV-2 and other viral pathogens in the wastewater-water-drinking water continuum and the associated risk assessment are still lacking. Therefore, to address this gap, the present paper makes the following contributions: (1) critically examines the early empirical results to highlight the occurrence and stability of SARS-CoV-2 in the wastewater-source water-drinking water continuum, (2) discusses the anthropogenic and hydro(geo)logical processes controlling the circulation of SARS-CoV-2 in the wastewater-source water-drinking water continuum, (3) discusses the risky behaviour, drivers and high-risk settings in the wastewater-source water-drinking water continuum, (4) uses the available empirical data on SARS-CoV-2 occurrence in the wastewater-source water-drinking water continuum to discuss human health risks from multiple exposure pathways, gendered aspects of SARS-CoV-2 transmission via shared on-site sanitation systems, and (5) develops and risk mitigation strategy based on the available empirical evidence and quantitative human risk assessment data. Finally, it presents a comprehensive research agenda on SARS-CoV-2/COVID-19 to guide the mitigation of future similar outbreaks in low-income settings.

Assessing the impact of food trade centric on land, water, and food security in South Korea.

The observed and predicted changes in climate, as well as the growth in urban population, are creating severe stress on existing water resources in South Korea. By the importation of agricultural products from more water-rich countries through the virtual water concept, a country could save local water resources for other important uses. However, these imports from other countries could lead to certain vulnerabilities in the importing country derived from climate change. Therefore, through the application of the virtual water concept and the climate vulnerability index ((CVI) - measure of a country's vulnerability to indirect climate impacts), this study assessed the implication of virtual water imports and climate change through food trade, on the water, land and food security status of South Korea over the period of 2000-2017. The results showed that significant amounts of national water and land was saved through the importation of major upland crops. Virtual water imports increased significantly over time, rising from 16.2 Bm3 in 2000 to 16.5, 17.4, and 20.7 Bm3 in 2005, 2011, and 2017 respectively, with the USA, China, Australia, Brazil and Canada being the major exporters to South Korea. The study also revealed high CVI values for the oils and grains category of imported food, implying the high vulnerability of South Korea to climate change effects resulting from the import of these crops. The quantitative impacts and structural changes in virtual water trade, as well as the link between climate change, food security, international trade, and domestic water consumption could be evaluated for the sustainable management and allocation of resources. This study successfully identified and quantified the status of food trade and its environmental implications in the study area, providing insight into a better allocation of locally available resources.

Spatial Assessment of Potentially Toxic Elements (PTE) Concentration in Agaricus bisporus Mushroom Collected from Local Vegetable Markets of Uttarakhand State, India.

This study presents a spatial assessment of eight potentially toxic elements (PTE: Cd, Cr, Cu, Fe, Pb, Ni, Mn, and Zn) in white button (Agaricus bisporus J.E. Lange) mushroom samples collected from the local vegetable markets of Uttarakhand State, India. Fresh A. bisporus samples were collected from thirteen districts and fifteen sampling locations (M1-M15) and analyzed for the concentration of these PTE using atomic absorption spectroscopy (AAS). The results revealed that A. bisporus contained all eight selected PTE in all sampling locations. Based on the inverse distance weighted (IDW) interpolation, principal component (PC), and hierarchical cluster (HC) analyses, the areas with a plane geographical distribution showed the highest PTE concentrations in the A. bisporus samples as compared to those in hilly areas. Overall, the decreasing order of PTE concentration in A. bisporus was recognized as Fe > Zn > Mn > Cr > Cu > Ni > Cd > Pb. The Kruskal−Wallis ANOVA tests displayed a highly significant (p < 0.05) difference among the sampling locations. However, the concentration of PTE was below permissible limits, indicating no potential hazard in consuming the A. bisporus. Similarly, the health risk assessment studies using the target hazard quotient (THQ) also showed no significant health risk associated with the consumption of A. bisporus being sold in the local mushroom markets of Uttarakhand, India. This study is the first report on state-level monitoring of PTE in A. bisporus mushrooms, which provides crucial information regarding the monitoring and occurrence of potentially toxic metallic elements.

Foliar use of TiO2-nanoparticles for okra (Abelmoschus esculentus L. Moench) cultivation on sewage sludge-amended soils: biochemical response and heavy metal accumulation.

Considering its richness in organic and inorganic mineral nutrients, the recycling of sewage sludge (SS) is highly considered as a soil supplement in agriculture. However, the fate of hazardous heavy metal accumulation in the crops cultivated in SS amended soils is always a source of concern. Since nanoparticles are widely recognized to reduce heavy metal uptake by crop plants; thus, the present experiment deals with okra (Abelmoschus esculentus L. Moench) cultivation under the combined application of SS and TiO2-nanoparticles (NPs). Triplicated pot experiments were conducted using different doses of SS and TiO2-NPs such as 0 g/kg SS (control), 50 g/kg SS, 50 g/kg SS + TiO2, 100 g/kg SS, and 100 g/kg SS + TiO2, respectively. The findings of this study indicated that among the doses of treatment combinations investigated, 100 g/kg SS + TiO2 showed a significant (p < 0.05) increase in the okra plant yield (287.87 ± 4.06 g/plant) and other biochemical parameters such as fruit length (13.97 ± 0.54 cm), plant height (75.05 ± 3.18 cm), superoxide dismutase (SOD: 110.68 ± 3.11 µ/mg), catalase (CAT: 81.32 ± 3.52 µ/mg), and chlorophyll content (3.12 ± 0.05 mg/g fwt.). Also, the maximum contents of six heavy metals in the soil and cultivated okra plant tissues (fruit, stem, and root regions) followed the order of Fe > Mn > Cu > Zn > Cr > Cd using the same treatment. Bioaccumulation and health risk assessment indicated that foliar application of TiO2-NPs significantly reduced the fate of heavy metal accumulation under higher doses of SS application. Therefore, the findings of this study suggested that the combined use of SS and TiO2-NPs may be useful in ameliorating the negative consequences of heavy metal accumulation in cultivated okra crops.

Sustainable Use of Sewage Sludge as a Casing Material for Button Mushroom (Agaricus bisporus) Cultivation: Experimental and Prediction Modeling Studies for Uptake of Metal Elements.

The present study focused on the use of sewage sludge (SS) as a casing material amendment and the potential uptake of metal elements by the cultivated white button (Agaricus bisporus: MS-39) mushroom. Laboratory experiments were performed under controlled environmental conditions to grow A. bisporus on the composted wheat straw substrate for 50 days. Different treatments (0, 50, 100, 150, and 200 g/kg) of casing material were prepared by mixing garden and dried SS and applied on the mushroom substrate after proper sterilization. The results revealed that SS application was significant (p < 0.05) in accelerating mushroom yield with a biological efficiency of 65.02% for the mixing rate of 200 g/kg. Moreover, the maximum bioaccumulation of selected metal elements (Cu, Cr, Cd, Fe, Mn, and Zn) was observed using the same treatment. Additionally, the multiple regression models constructed for the uptake prediction of metal elements showed an acceptable coefficient of determination (R2 > 0.9900), high model efficiency (ME > 0.98), and low root mean square error (RMSE < 0.410) values, respectively. The findings of this study represent sustainable use of SS for the formulation of mushroom casing material contributing toward synergistic agro-economy generation and waste management.

A safe haven of SARS-CoV-2 in the environment: Prevalence and potential transmission risks in the effluent, sludge, and biosolids.

The novel coronavirus, SARS-CoV-2, which has caused millions of death globally is recognized to be unstable and recalcitrant in the environment, especially in the way it has been evolving to form new and highly transmissible variants. Of particular concerns are human-environment interactions and the handling and reusing the environmental materials, such as effluents, sludge, or biosolids laden with the SARS-CoV-2 without adequate treatments, thereby suggesting potential transmission and health risks. This study assesses the prevalence of SARS-CoV-2 RNA in effluents, sludge, and biosolids. Further, we evaluate the environmental, ecological, and health risks of reusing these environmental materials by wastewater/sludge workers and farmers. A systematic review of literature from the Scopus database resulted in a total of 21 articles (11 for effluents, 8 for sludge, and 2 for biosolids) that met the criteria for meta-analysis, which are then subdivided into 30 meta-analyzed studies. The prevalence of SAR-CoV-2 RNA in effluent and sludge based on random-effect models are 27.51 and 1012.25, respectively, with a 95% CI between 6.14 and 48.89 for the effluent, and 104.78 and 1019.71 for the sludge. However, the prevalence of SARS-CoV-2 RNA in the biosolids based on the fixed-effect model is 30.59, with a 95% CI between 10.10 and 51.08. The prevalence of SARS-CoV-2 RNA in environmental materials indicates the inefficiency in some of the treatment systems currently deployed to inactivate and remove the novel virus, which could be a potential health risk concern to vulnerable wastewater workers in particular, and the environmental and ecological issues for the population at large. This timely review portends the associated risks in handling and reusing environmental materials without proper and adequate treatments.

Modeling of mineral elements uptake and localization in cabbage inflorescence (Brassica oleracea var. capitata) grown on sugar mill pressmud-amended soils.

Sugar mill pressmud is highly considered and used as a supplement to improve soil fertility and crop yield, especially in India. This study investigated the growth and yield performance of cultivated cabbage (Brassica oleracea var. capitata) on sugar mill pressmud amended soil. Pot experiments were performed using various pressmud amendment rates (0, 50, 100, and 150 g/kg soil) to study the fertilization impact on cabbage inflorescence yield (g) and size (diameter: cm). Moreover, mineral element (Cd, Cr, Cu, Fe, Mn, and Zn) accumulation in the cabbage inflorescence was also studied using a modified polynomial non-linear model. Results showed that the sugar mill pressmud had significantly (p < 0.05) higher nutrient elements which induced their concentration in the soil after mixing. Also, the highest yield (849.25 ± 7.47 g), size (15.10 ± 1.50 cm diameter), and dry weight (42.13 g) of cabbage inflorescence were attained using 100 g/kg pressmud treatment with a maximum significant (p < 0.05) accumulation of mineral elements. However, the highest accumulation of mineral elements was observed in the outer zones (Z1 and Z2) of leafy inflorescence as compared to inner zones (Z3 and Z4), respectively. The mineral elements in both outer and inner zones of cabbage followed an order of Fe > Mn > Zn > Cu > Cr > Zn. Furthermore, the developed modified polynomial quadratic model precisely predicted the total mineral element uptake (mg dwt.) by cabbage inflorescence. The models had good fitness as described by the coefficient of determination (R2 > 0.992) values. This study suggested that sugar mill pressmud was a promising resource for cabbage cultivation, and the developed models were helpful in the precise prediction of mineral elements accumulated by its inflorescence.

Monitoring the presence and persistence of SARS-CoV-2 in water-food-environmental compartments: State of the knowledge and research needs.

The recent spread of severe acute respiratory syndrome coronavirus (SAR-CoV-2) and the accompanied coronavirus disease 2019 (COVID-19) has continued ceaselessly despite the implementations of popular measures, which include social distancing and outdoor face masking as recommended by the World Health Organization. Due to the unstable nature of the virus, leading to the emergence of new variants that are claimed to be more and rapidly transmissible, there is a need for further consideration of the alternative potential pathways of the virus transmissions to provide the needed and effective control measures. This review aims to address this important issue by examining the transmission pathways of SARS-CoV-2 via indirect contacts such as fomites and aerosols, extending to water, food, and other environmental compartments. This is essentially required to shed more light regarding the speculation of the virus spread through these media as the available information regarding this is fragmented in the literature. The existing state of the information on the presence and persistence of SARS-CoV-2 in water-food-environmental compartments is essential for cause-and-effect relationships of human interactions and environmental samples to safeguard the possible transmission and associated risks through these media. Furthermore, the integration of effective remedial measures previously used to tackle the viral outbreaks and pandemics, and the development of new sustainable measures targeting at monitoring and curbing the spread of SARS-CoV-2 were emphasized. This study concluded that alternative transmission pathways via human interactions with environmental samples should not be ignored due to the evolving of more infectious and transmissible SARS-CoV-2 variants.

Assessment of environmental and economic aspects of household food waste using a new Environmental-Economic Footprint (EN-EC) index: A case study of Daegu, South Korea.

While the global food demand has continued to increase, the enormous natural resources required for its production are limited, in addition to the accompanying environmental degradation. Despite all these, food waste generation continues unabated, especially at the household level, further compounding the environmental impacts, economic cost, and food security issues. In this study, granular primary data of edible household food waste using direct-weighing from 218 households in Daegu, South Korea was used to assess the environmental (carbon footprint, and water footprint) and economic (wasted cost) impacts associated with their wastage. For the first time, the Environmental-Economic (EN-EC) Footprint index is proposed as a single indicator for environmental and economic impacts to assess the hotspot food waste products among the selected 42 major food waste items. This study presents that the selected food products had a significant contribution to an average edible food waste generation of 0.73 ± 0.06 kg (per household/day), 0.71 ± 0.05 kg CO2eq of GHG emissions, 0.46 ± 0.04 m3 of water footprint, and 3855.93 ± 527.27 won of economic loss, respectively. Based on the newly developed EN-EC Footprint index, we found that wasted animal-based food products had relatively high environmental and economic losses compared to non-animal-based food products. The findings of this study presented a novel method of estimating combined environmental and economic impacts associated with household food waste, which may further act as convenient guides for the waste management authorities and policymakers in addressing the mitigation of household food waste impacts.

Assessment of food waste generation and composition among Korean households using novel sampling and statistical approaches.

Food waste management in Korea has become increasingly important as the country continues to champion the transition into a circular economy among the OECD countries to achieve sustainable development target goals. However, reliable primary data on food waste quantity and composition to achieve its prevention and managementtargets by understanding food waste patterns among Korean households is poorly documented. This study investigates the quantity and composition of food waste generation rates among the sampled households by considering two important influencing factors of seasonality and housing types in the Buk-gu province of Daegu, South Korea. The food waste generation rates from three different housing types during four representative seasons were assessed, considering the availability of different food types at different seasons. The identified 46 food waste items from sampled data were statistically analyzed using the Kruskal-Wallis statistical test. The results showed that food waste generation rates were 0.88 ± 0.37 kg/household/day (0.26 ± 0.11 kg/capita/day), which varied seasonally. Significant seasonal variations (P < 0.002) in food waste generated from the selected housing types were shown by K-W mean rank analysis. The food waste generation rate followed the seasonal order of summer > autumn > winter > spring. The effect of housing type was also a pivotal factor affecting the food waste generation. This study adds to the ground-level insights of food waste generation trends in different seasons and housing types of Korea.

Exploring the Subjective Frame of References in the Development of Gerotranscendence in Korean Older Adults: Q Methodology.

Introduction: This study aims to explore how older people structure the subjectivity that accompanies the development of gerotranscendence in late adulthood within a specific sociocultural context. Method: Q methodology, a common method for assessing subjectivity, was applied. Results: The four subjective frames of reference that accompany the development of gerotranscendence, represented by four corresponding Q-factors, were (a) generation awareness, (b) awareness of aging, (c) awareness of the big picture of life, and (d) awareness of temporality. Discussion: The subjective frames of reference that characterize the development of gerotranscendence in late adulthood are closely related to cultural and psychosocial environmental influences over the course of an individual's life.

Insights into hazardous solid waste generation during COVID-19 pandemic and sustainable management approaches for developing countries.

The recent emergence of the COVID-19 pandemic has contributed to the drastic production and use of healthcare and personal protective equipment, leading to the release of a huge quantity of hazardous medical and solid wastes in the environment. Meanwhile, these solid wastes may contribute to the spread of the SARS-CoV-2 viral particles when disposed of without proper treatment and care. Since SARS-CoV-2 could persist on different material surfaces including plastic, steel, paper, cardboard, cloth, and wood, proper management of these hazardous solid wastes has become a challenging task during the COVID-19 pandemic. In this paper, an overview of the consumption of COVID-19-related healthcare and personal protective equipment along with the production of hazardous solid waste is presented. The efficient management of these wastes is necessary to prevent the entering of SARS-CoV-2 in various environmental compartments. Therefore, some preventive measures including the use of biodegradable materials for manufacturing personal protective equipment, minimizing the use of non-biodegradable materials, efficient pre- and-post planning, careful segregation, and disposal are, therefore, proposed for their sustainable management. The findings reported in this paper contribute to tackling the problems associated with hazardous solid waste management, particularly for low- and middle-income countries.

Understanding the impacts of the COVID-19 pandemic on sustainable agri-food system and agroecosystem decarbonization nexus: A review.

The existing finite natural resources have witnessed unsustainable usage in the past few years, especially for food production, with accompanying environmental devastation and ecosystem damage. Regrettably, the global population and consumption demands are increasing ceaselessly, leading to the need for more resources for food production, which could potentially aggravate the sustainability and ecosystem degradation issues, while stimulating drastic climate change. Meanwhile, the unexpected emergence of the COVID-19 pandemic and some implemented measures to combat its spread disrupted agricultural activities and the food supply chain, which also led to a reduction in ecosystem carbonization. This study sets out to explore policy framework and selected feasible actions that are being adopted during the COVID-19 pandemic, which could potentially reduce the emissions even after the pandemic to promote a resilient and sustainable agri-food system. In this study, we reviewed 27 articles that focus on the current state of the agri-food system in light of the COVID-19 pandemic and its impact on the decarbonization of the agroecosystem. This review has taken the form of a systematic methodology in analyzing the adoption and implementation of various measures to mitigate the spread of COVID-19 on the impact of the agri-food system and reduction in ecosystem degradation. Up to 0.3 Mt of CO2 reduction from the agri-food system alone was reportedly achieved during the first 6 months of the pandemic in 23 European countries. The various adopted measures indicate that the circular economy approach is a panacea to achieve the needed sustainability in the agri-food system. Also, it dictates a need for a paradigm change towards improvement on localized food production that promotes sustainable production and consumption.

Assessment of socioeconomic inequality based on virus-contaminated water usage in developing countries: A review.

Water is an essential resource required for various human activities such as drinking, cooking, and other recreational activities. While developed nations have made significant improvement in providing adequate quality water and sanitation devoid of virus contaminations to a significant percentage of the residences, many of the developing countries are still lacking in these regards, leading to many death cases among the vulnerable due to ingestion of virus-contaminated water and other waterborne pathogens. However, the recent global pandemic of COVID-19 seems to have changed the paradigm by reawakening the importance of water quality and sanitation, and focusing more attention on the pervasive effect of the use of virus-contaminated water as it can be a potential driver for the spread of the virus and other waterborne diseases, especially in developing nations that are characterized by low socioeconomic development. Therefore, this review assessed the socioeconomic inequalities related to the usage of virus-contaminated water and other waterborne pathogens in developing countries. The socioeconomic factors attributed to the various waterborne diseases due to the use of virus-contaminated water in many developing countries are poverty, the standard of living, access to health care facilities, age, gender, and level of education. Some mitigation strategies to address the viral contamination of water sources are therefore proposed, while future scope and recommendations on tackling the essential issues related to socioeconomic inequality in developing nations are highlighted.

Snowballing transmission of COVID-19 (SARS-CoV-2) through wastewater: Any sustainable preventive measures to curtail the scourge in low-income countries?

In this communication, we proposed sustainable preventive measures that may be adopted by the low-income countries to forestall the potential outbreak and transmission of COVID-19 (coronavirus disease 2019) through wastewater. Most low-income countries have poor sanitation and wastewater management policies, which create potential risks of COVID 19 spread. Hence, the proposed measures include decentralization of wastewater treatment facilities, community-wide monitoring and testing of SARS-CoV-2 in wastewater samples, improved sanitation, developing point-of-use devices for wastewater decontamination, and more focused policy interventions. Therefore, this paper adds useful insights into the monitoring and management of ongoing COVID-19 outbreak in low-income countries.

Characterization of New Bioactive Enzyme Inhibitors from Endophytic Bacillus amyloliquefaciens RWL-1.

Endophytic bacteria are known to produce a wide array of bioactive secondary metabolites with beneficial effects on human health. In the current study, a novel endophytic bacterial strain, Bacillus amyloliquefaciens RWL-1, was isolated from the seeds of Oryza sativa. Initially, the crude extract of RWL-1 was assessed for potential biological effects of enzyme inhibition and cytotoxicity and was found to exhibit a broad spectrum inhibition for α-glucosidase (37 ± 0.09%) and urease (49.4 ± 0.53%). The screening results were followed by bioassay-guided isolation of secondary metabolite(s) from RWL-1. Extensive chromatographic and spectrophotometry analyses revealed the presence of compound 1 (S)-2-hydroxy-N-((S)-1-((S)-8-hydroxy-1-oxoisochroman-3-yl)-3-methylbutyl)-2-((S)-5-oxo-2,5-dihydrofuran-2-yl)acetamide. Further bioassays of compound 1 showed significant inhibition of α-glucosidase (52.98 ± 0.8%) and urease (51.27 ± 1.0%), compared with positive control values of 79.14 ± 1.9% and 88.24 ± 2.2%, and negative controls (0.08 ± 0.1% and 0.05 ± 0.01%), respectively. The current study suggests that bacterial endophytes are a rich source of novel bioactive compounds with high therapeutic value.

A psychological intervention programme for patients with breast cancer under chemotherapy and at a high risk of depression: A randomised clinical trial.

AIMS AND OBJECTIVES: To develop a nurse-led psychological intervention programme and to evaluate its effects on psychological distress and quality of life in patients with breast cancer undergoing chemotherapy and at a high risk of depression. BACKGROUND: Depression is common among patients with breast cancer undergoing chemotherapy. Psychological intervention programmes that improve psychological distress and quality of life have previously been lacking in South Korea. DESIGN: This was a pre- and post-test randomised controlled trial. METHODS: The nurse-led psychological intervention programme comprised seven weekly counselling sessions delivered face to face and telephonically. These aimed to provide emotional support to patients and to enable them to express their feelings. Patients at a high risk of depression were recruited from an oncology outpatient clinic in a university hospital. Sixty participants were evenly and randomly allocated to either the intervention group or the control group. The effects of the intervention on psychological distress (mood disturbance, anxiety and depression) and quality of life were examined using linear mixed models. RESULTS: Compared with the control group, the intervention group reported significantly lower mood disturbance, anxiety and depression and showed an improved global health status and physical, role and emotional functions. They also reported fewer symptoms such as fatigue, nausea/vomiting, pain and insomnia. CONCLUSIONS: Our nurse-led psychological intervention programme might reduce patients' uncertainty and encourage them to be proactive and self-controllable. RELEVANCE TO CLINICAL PRACTICE: Nurse-led psychological intervention programmes should be implemented to reduce psychological distress and improve quality of life in patients with breast cancer, particularly those at a high risk of depression.

Subjective Health and Factors of Health-related Quality of Life in Elderly Haenyo.

PURPOSE: To investigate the subjective health and health-related quality of life (HRQoL) in Haenyo. METHODS: Subjects were 100 elderly Haenyo in Jeju island who belonged to a fishing-village society. Main variables were activities of daily living (ADL), instrumental ADL (IADL), the HRQoL, subjective health, and depression. Subjective health and differences of HRQoL by variables were analyzed by t-test or ANOVA using IBM SPSS Statistics 23. Hierarchical multiple regression was executed to examine the effects of the major factors on the quality of life. RESULTS: The mean age was 69.9 years, the mean period for diving career was 51.5 years, and work hours per month were 37.8. Comorbidity of diseases was 2.74, and the common health problems were osteoporosis and headache/dizziness. HRQoL was significantly different by age (F=4.52, p=.013), education (F=6.10, p=.003), muljil work years (F=3.93, p=.050), depression (t=-3.04, p=.030), subjective health state (F=30.62, p < .01), and degenerative arthritis (F=-2.38, p=.019). In the final model by hierarchical multiple regression, ADL/IADL (ß=.41, p < .001), depression (ß=-.29, p < .001), and subjective health (ß=.43~.51, p < .001) were significant and explained 63.5% of the total variance of HRQoL. CONCLUSION: Haenyo have specific health problems different from those of elderly women in general. ADL/IADL, depression and subjective health affected their HRQoL. It is clear that Haenyos' health problems need further study to improve their health.

Experiences of Prenatal Genetic Screening and Diagnostic Testing Among Pregnant Korean Women of Advanced Maternal Age.

PURPOSE: This study explored the experiences of Korean women of advanced maternal age undergoing prenatal genetic screening and diagnostic testing. DESIGN: A descriptive, qualitative design was used to guide the study. METHOD: Ten participants were purposely recruited from a large metropolitan Korean hospital for clinical observations and individual, semistructured interviews. The content analysis method was used to analyze field notes and interview transcripts. FINDINGS: Three themes emerged: reacting to an unfavorable screening result, dealing with the anticipated consequences of diagnostic testing, and realistically embracing the unborn child. CONCLUSIONS: The findings of this study inform the development of tailored interventions aimed at reducing the heavy emotional burdens placed on pregnant women and the stigma of bearing children with genetic conditions. Clear reciprocal communication and shared decision making should be promoted in the day-to-day practice of delivering health care for pregnant Korean women.