Efficacy and Safety of Enavogliflozin versus Dapagliflozin as Add-on to Metformin in Patients with Type 2 Diabetes Mellitus: A 24-Week, Double-Blind, Randomized Trial

Background@#Enavogliflozin is a novel sodium-glucose cotransporter-2 inhibitor currently under clinical development. This study evaluated the efficacy and safety of enavogliflozin as an add-on to metformin in Korean patients with type 2 diabetes mellitus (T2DM) against dapagliflozin. @*Methods@#In this multicenter, double-blind, randomized, phase 3 study, 200 patients were randomized to receive enavogliflozin 0.3 mg/day (n=101) or dapagliflozin 10 mg/day (n=99) in addition to ongoing metformin therapy for 24 weeks. The primary objective of the study was to prove the non-inferiority of enavogliflozin to dapagliflozin in glycosylated hemoglobin (HbA1c) change at week 24 (non-inferiority margin of 0.35%) (Clinical trial registration number: NCT04634500). @*Results@#Adjusted mean change of HbA1c at week 24 was –0.80% with enavogliflozin and –0.75% with dapagliflozin (difference, –0.04%; 95% confidence interval, –0.21% to 0.12%). Percentages of patients achieving HbA1c <7.0% were 61% and 62%, respectively. Adjusted mean change of fasting plasma glucose at week 24 was –32.53 and –29.14 mg/dL. An increase in urine glucose-creatinine ratio (60.48 vs. 44.94, P<0.0001) and decrease in homeostasis model assessment of insulin resistance (–1.85 vs. –1.31, P=0.0041) were significantly greater with enavogliflozin than dapagliflozin at week 24. Beneficial effects of enavogliflozin on body weight (–3.77 kg vs. –3.58 kg) and blood pressure (systolic/diastolic, –5.93/–5.41 mm Hg vs. –6.57/–4.26 mm Hg) were comparable with those of dapagliflozin, and both drugs were safe and well-tolerated. @*Conclusion@#Enavogliflozin added to metformin significantly improved glycemic control in patients with T2DM and was non-inferior to dapagliflozin 10 mg, suggesting enavogliflozin as a viable treatment option for patients with inadequate glycemic control on metformin alone.

The Impact of Fear and Perception of Infection Risk on Depression among Service Workers during Covid-19 / 한국직업건강간호학회지

Purpose@#This study aimed to examine the impact of fear and perception of infection risk on depression among service workers during prolonged Covid-19 service, and to provide basic data on the impact of COVID-19 prevention on the psychological health of service workers. @*Methods@#Data were collected from workers nationwide from May 24 to 31, 2021. The data were analyzed using the t-test, ANOVA, Scheffé test, Pearson’s correlation coefficient, and multiple regression analysis, using SPSS 28. @*Results@#It was found that 44.3% of the participants experienced depression (PHQ-9 total scores ≥ 10) during the Covid-19 pandemic. The general characteristics of service workers that made a difference in the level of depression were health status, smoking, and perception of infection risk. @*Conclusion@#Social support from institutions is needed to treat depression caused by Covid-19 among workers in the service sector.

Analysis of Clinicopathological Features and Risk Factors for Severe Complications after Gastrectomy for Gastric Cancer in Elderly Patients

Objective@#As life expectancy is increasing, the number and proportion of elderly patients with gastric cancer are also expanded. This study aimed to investigate the clinicopathological features for elderly gastric cancer patients undergoing gastrectomy and analyze risk factors for developing severe complications. @*Methods@#A total of 514 patients treated surgically for gastric cancer between January 2016 and December 2019 were enrolled in this retrospective study. Patients were divided into two groups: younger group ( ≤ 69 years) and elderly group ( ≥ 70 years). Clinicopathological characteristics and operative outcomes including the complications and mortality were compared between two groups. Risk factors for severe complications in elderly gastric cancer patients were also investigated. @*Results@#Of the 514 patients, 145 (28.2%) were elderly group. Comorbidity (P < 0.001), differentiated histology (P = -0.006), deeper in tumor depth (P = 0.012), and frequent lymph node metastasis (P = 0.028) were observed in elderly group. Overall complications (P = 0.046) and severe complications (P = 0.049) were significantly higher in elderly group. Multivariate analysis indicated that extent of resection (P = 0.044) was associated with severe complications in elderly gastric cancer patients. @*Conclusion@#Elderly patients have a significantly higher probability of complications and severe complications than younger patients after gastrectomy for gastric cancer. Especially, when total gastrectomy was performed in elderly gastric cancer patients, the risk of developing serious complications was significantly higher more than 3 times. Therefore, surgeons should pay attention to gastric cancer patients over the age of 70 who require total gastrectomy.

Torsion of a Wandering Spleen Treated by Laparoscopic Surgery: A Case Report

The spleen is an organ located in the upper left portion of the abdomen. Wandering spleen is defined as the location of the spleen is the shift to other parts of the abdomen rather than the left upper quadrant. Wandering spleen is a rare clinical condition and can lead to hilar torsion and subsequent infarction requiring emergency surgery. The author presents a case of torsion of a wandering spleen in a 34-year-old female presenting with abdominal pain. The patients underwent emergent laparoscopic splenectomy. She had an uncomplicated postoperative course and recovered well.

Anti-inflammatory Effects of Sanguisorbae Radix on Contact Dermatitis Induced by Dinitrofluorobenzene in Mice / 中国结合医学杂志

OBJECTIVE@#To investigate the anti-inflflammatory effects of Sanguisorbae Radix on contact dermatitis (CD).@*METHODS@#Mice were sensitized by painting 30 µL of 1-fluoro-2,4-dinitrofluorobenzene (DNFB) onto each ear for 3 days. Four days later, mice were challenged by painting with 50 µL of DNFB onto the shaved dorsum every 2 days. Sanguisorbae Radix methanol extract (MESR) was applied onto the shaved dorsum every 2 days. The effects of MESR on skin thickness, skin weights, histopathological changes, skin lesions and cytokine production in DNFB-induced CD mice were investigated, as well as its effects on body weights and spleen/body weight ratio.@*RESULTS@#Topical application of MESR effectively inhibited enlargement of skin thickness and weight (P<0.05). MESR treatment also inhibited hyperplasia, spongiosis and immune cell infiltration induced by DNFB in inflamed tissues and improved lesions on dorsum skin in CD mice. Moreover, treatment with MESR suppressed the increase in the levels of tumor necrosis factor α (TNF-α,P<0.01) and interferon γ (IFN-γ,P<0.05), respectively. Finally, MESR had no effect on body weight gain or spleen/body weight ratio.@*CONCLUSION@#These data suggest that MESR acts as an anti-inflflammatory agent that decreases the production of TNF-α and IFN-γ, resulting in reductions of skin lesions and histopathological changes in inflamed skin tissues.

Prospective Multicenter Feasibility Study of Laparoscopic Sentinel Basin Dissection after Endoscopic Submucosal Dissection for Early Gastric Cancer: SENORITA 2 Trial Protocol

PURPOSE: Although standard radical gastrectomy is recommended after noncurative resection of endoscopic submucosal dissection (ESD) for early gastric cancer in most cases, residual tumor and lymph node metastasis have not been identified after surgery. The aim of this study is to evaluate the feasibility of sentinel node navigation surgery after noncurative ESD. MATERIALS AND METHODS: This trial is an investigator-initiated, multicenter prospective phase II trial. Patients who underwent ESD for clinical stage T1N0M0 gastric cancer with noncurative resections were eligible. Qualified investigators who completed the prior phase III trial (SENORITA 1) are exclusively allowed to participate. In this study, 2 detection methods will be used: 1) intraoperative endoscopic submucosal injection of dual tracer, including radioisotope and indocyanine green (ICG) with sentinel basins detected using gamma-probe; 2) endoscopic injection of ICG, with sentinel basins detected using a fluorescence imaging system. Standard laparoscopic gastrectomy with lymphadenectomy will be performed. Sample size is calculated based on the inferior confidence interval of the detection rate of 95%, and the calculated accrual is 237 patients. The primary endpoint is detection rate, and the secondary endpoints are sensitivity and postoperative complications. CONCLUSIONS: This study is expected to clarify the feasibility of laparoscopic sentinel basin dissection after noncurative ESD. If the feasibility is demonstrated, a multicenter phase III trial will be initiated to compare laparoscopic sentinel node navigation surgery versus laparoscopic standard gastrectomy in early gastric cancer after endoscopic resection. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03123042

Adaptation to Motherhood in Central Asian-Korean Immigrants to Korea: A Grounded Theory Study

PURPOSE: This qualitative study aimed to develop a substantive theory of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea.METHODS: Individual, in-depth interviews were conducted from July to September 2017, with 18 women who emigrated of Korean ethnicity from Central Asia to Korea, and took care of their baby for at least a year after their first delivery in Korea. The interviews were audio-recorded and transcribed verbatim. Data from the transcriptions were analyzed through Strauss and Corbin's grounded theory method, and data analysis was conducted simultaneously with data collection.RESULTS: As a result of categorizing the interview data through the process of open coding, 10 categories, with 31 subcategories and 102 concepts were drawn, and “growth as a Central Asian-Korean mother in an unfamiliar, historical hometown” was found to be the core category of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea.CONCLUSION: A characteristic of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea, drawn from this study, is that it differs according to the level of initiative to carry out interaction strategies, and the use of various supportive social resources. The findings indicate the need for Medicare eligibility adjustment for antenatal care, the extension of the visa renewal period during childbirth, the development of web- or mobile application-based educational programs in Russian language, and the establishment of integrated visiting healthcare services, community service resources, and policy support to enable these women to utilize various supportive social resources.

Adaptation to Motherhood in Central Asian-Korean Immigrants to Korea: A Grounded Theory Study

Purpose@#This qualitative study aimed to develop a substantive theory of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea. @*Methods@#Individual, in-depth interviews were conducted from July to September 2017, with 18 women who emigrated of Korean ethnicity from Central Asia to Korea, and took care of their baby for at least a year after their first delivery in Korea. The interviews were audio-recorded and transcribed verbatim. Data from the transcriptions were analyzed through Strauss and Corbin's grounded theory method, and data analysis was conducted simultaneously with data collection. @*Results@#As a result of categorizing the interview data through the process of open coding, 10 categories, with 31 subcategories and 102 concepts were drawn, and “growth as a Central Asian-Korean mother in an unfamiliar, historical hometown” was found to be the core category of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea. @*Conclusion@#A characteristic of the process of adaptation to motherhood in Central Asian-Korean immigrants to Korea, drawn from this study, is that it differs according to the level of initiative to carry out interaction strategies, and the use of various supportive social resources. The findings indicate the need for Medicare eligibility adjustment for antenatal care, the extension of the visa renewal period during childbirth, the development of web- or mobile application-based educational programs in Russian language, and the establishment of integrated visiting healthcare services, community service resources, and policy support to enable these women to utilize various supportive social resources.

Feasibility and Effects of a Postoperative Recovery Exercise Program Developed Specifically for Gastric Cancer Patients (PREP-GC) Undergoing Minimally Invasive Gastrectomy

PURPOSE: Exercise intervention after surgery has been found to improve physical fitness and quality of life (QOL). The purpose of this study was to investigate the feasibility and effects of a postoperative recovery exercise program developed specifically for gastric cancer patients (PREP-GC) undergoing minimally invasive gastrectomy. MATERIALS AND METHODS: Twenty-four patients treated surgically for early gastric cancer were enrolled in the PREP-GC. The exercise program comprised sessions of In-hospital Exercise (1 week), Home Exercise (1 week), and Fitness Improvement Exercise (8 weeks). Adherence and compliance to PREP-GC were evaluated. In addition, body composition, physical fitness, and QOL were assessed during the preoperative period, after the postoperative recovery (2 weeks after surgery), and upon completing the PREP-GC (10 weeks after surgery). RESULTS: Of the 24 enrolled patients, 20 completed the study without any adverse events related to the PREP-GC. Adherence and compliance rates to the Fitness Improvement Exercise were 79.4% and 99.4%, respectively. Upon completing the PREP-GC, patients also exhibited restored cardiopulmonary function and muscular strength, with improved muscular endurance and flexibility (P < 0.05). Compared to those in the preoperative period, no differences were found in symptom scale scores measured using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) and Quality of Life Questionnaire-Stomach Cancer-Specific Module (QLQ-STO22); however, higher scores for global health status and emotional functioning were observed after completing the PREP-GC (P < 0.05). CONCLUSIONS: In gastric cancer patients undergoing minimally invasive gastrectomy, PREP-GC was found to be feasible and safe, with high adherence and compliance. Although randomized studies evaluating the benefits of exercise intervention during postoperative recovery are needed, surgeons should encourage patients to participate in systematic exercise intervention programs in the early postoperative period (Registered at the ClinicalTrials.gov NCT01751880).

Child Rearing Experience of Mothers of School-Age Children with Autism Spectrum Disorders

PURPOSE: The purpose of this study was to describe the child rearing experience of mothers of school-age children with autism spectrum disorders in Korea. METHODS: Seven mothers were interviewed from October 2015 to January 2016. Interviews were transcribed verbatim and analyzed using Giorgi's phenomenological method. RESULTS: The study results showed that the child rearing experience of mothers of school-age children with autism spectrum disorders consists of six major themes: “facing unexpected situations”, “trying to accept children with disabilities”, “having considerably adjusted to the difficulties associated with the children's school life”, “experiencing frustrations”, “maintaining a child-centered life style”, and “being grateful for the present and looking forward to a better future”. CONCLUSION: The findings from this study show the need to provide more practically individualized and holistic services in the community for this population including their children such as lifetime education programs for the children and more financial aid for their therapies. In addition, the results reveal that mothers need physical, emotional, informational, financial, and social support to continue their life with children who have autism spectrum disorders.

Preoperative Lymphocyte-Monocyte Ratio Ameliorates the Accuracy of Differential Diagnosis in Non-Metastatic Infiltrative Renal Masses

PURPOSE: Distinguishing infiltrative renal cell carcinoma (RCC) from transitional cell carcinoma (TCC) is a challenging issue due to their radiologic similarities. We evaluated systemic inflammatory biomarkers as parameters for distinguishing tumor types. MATERIALS AND METHODS: A computerized search of medical records from November 2005 to October 2015 identified 116 patients with infiltrative renal masses who were difficult to diagnose confirmatively in radiological study. We investigated the diagnostic efficacy among these patients with their preoperative absolute neutrophil counts (ANC), absolute lymphocyte counts (ALC), absolute monocyte counts (AMC), neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). RESULTS: The infiltrative RCC group demonstrated significantly lower ALC {1449/µL (1140–1896), median [interquartile range (IQR)]} than the TCC group [1860/µL (1433–2342), p=0.016]. LMR [median (IQR)] also was lower in the infiltrative RCC group [2.98 (2.32–4.14) vs. TCC group 4.10 (2.86–6.09); p=0.011]. In subgroup analysis, non-metastatic infiltrative RCC showed lower ALC and LMR and higher NLR than non-metastatic TCC. Within non-metastatic infiltrative renal masses, multivariate logistic regression analysis revealed that younger patient age and lower LMR were associated with infiltrative RCC [odds ratios (OR) 0.874, p=0.024 and OR 0.461, p=0.048, respectively]. Receiver operating characteristic curve analysis showed that younger age and lower LMR were highly predictive of non-metastatic RCC (area under the curve=0.919, p<0.001). CONCLUSION: Age and LMR were significantly different between patients with infiltrative renal mass. These are potential markers for distinguishing between infiltrative RCC and TCC without metastasis.

Effects of a Cultural Competence Educational Program for Nursing Students / 간호행정학회지

PURPOSE: With the increase of foreigners using Korea health facilities, it is important for nurses to be culturally competent. Thus, the purpose of this study was to examine the effects of a cultural competence educational program on the cultural competence of nursing students. METHODS: A quasi-experimental study with a non-equivalent control group pretest-posttest design was used. For the experimental group there were 42 participants from one school and for the control group, 40 from another school. The experimental group participated in the 14 week multicultural nursing education program while the control group participated later after the experiment was finished. Data were collected using self-report structured questionnaires prior to the intervention and right after the intervention, and were analyzed using descriptive statistics, χ² test, and independent t-test with SPSS 18.0 program. RESULTS: The experimental group reported significant positive changes for cultural knowledge (t=3.99, p<.001), cultural awareness (t=3.92, p<.001), cultural acceptance (t=2.25, p=.027), and cultural competence behaviors (t=4.30, p<.001) compared to the control group. CONCLUSION: The results of the study indicate that the cultural competence educational program developed by the researchers is effective in raising the level of cultural knowledge, cultural awareness, cultural acceptance, and cultural competence behaviors of nursing students.

A Meta-Analysis of the Effect of Simulation-Based Education for Delivery Nursing in Korea

PURPOSE: The purpose of this study was to investigate the status of simulation-based education for delivery nursing performed in Korea and its effects. METHODS: report was prepared by guidelines presented by PRISMA group. The key words used for search were 'delivery nursing and simulation', 'obstetric nursing and simulation', or 'integrated nursing and simulation'. A total of 13 studies published in South Korea from 2012 to 2015 were included in the final analysis. The R with the 'metafor' package was used for the analysis. RESULTS: This study found that simulation-based education for delivery nursing was effective in improving clinical performance, clinical judgement, communication skills, confidence, knowledge, learning attitude, satisfaction, and self-efficacy and in reducing practice stress. CONCLUSION: This study reaffirms the effect of simulation-based education for delivery nursing. In order for nursing students to equip more flexible practice capability in this rapidly changing clinical field, the use of simulation-based learning is considered now almost essential. The result of this study can be used as a reference for evidence-based education for delivery nursing.

Tibial Schwannoma Mimicking a Popliteal Cyst / 대한정형외과학회잡지

Schwannoma is the most common benign tumor of peripheral nerves and usually appears on the trunk, head and neck, or extremities. A mass arising at popliteal fossa can be misdiagnosed as a popliteal cyst. We report on a rare case of a popliteal schwannoma mimicking a popliteal cyst in a 39-year-old female who showed a clinical presentation similar to that of a popliteal cyst. Diagnosis was delayed until ultrasonographic evaluation was performed due to its anatomical location, the same as that of a popliteal cyst. We describe the clinical significance and ultrasonographic findings of the schwannoma for initial differential diagnosis from a popliteal cyst.

Adaptation Process of Nurses Who Return to Work after Parental Leave / 간호행정학회지

PURPOSE: This study was conducted to generate a grounded substantive theory of the adaptation process of nurses who return to work after taking parental leave. METHODS: Individual in-depth interviews with 13 participants were conducted between June and September 2014. Participants were interviewed 1~3 times; interviews were continued until the data became saturated. Data were analyzed using Strauss and Corbin's grounded theory method. RESULTS: The core category of experience of the process of adaptation as a nurse who returned to work after parental leave was 'trying to regain one's previous position'. Participants used five interactional strategies: 'preparing in advance', 'initiating relationships with colleagues', 'keeping a positive attitude', 'understanding parenting helpers', 'Taking burden off one's mind'. CONCLUSION: The results of this study provide a theoretical basis for the adaptation process of nurses returning to work after taking parental leave. The importance of improving nurses' attitudes to their co-workers who take parental leave is highlighted along with the necessity of providing a family-friendly work environment. These results can be used to develop supportive policies and programs for nurses who return to their work after parental leave.

Oversight on the Bioethical Compliance of National R&D Projects or Research Personnel

BACKGROUND: Oversight on the bioethical compliance of national R&D projects or research personnel is currently conducted exclusively by IRB (Institutional Review Board) within the relevant research institute. Considering current state of affairs in Korea, there is an imperative to establish a national oversight system for bioethical compliance, conduct comprehensive oversight on bioethical compliance of national R&D projects, and enhance subject protection system. METHODS: We examined opinions from researchers and IRB personnels regarding ethical oversight system on R&D projects. Additionally, we looked at IRB assessment by KAIRB (Korea Association of Institutional Review Board) in order to identify status and problems with current IRB system in Korea. Assessment was also done for four other countries (US, UK, Germany, Singapore) through in-person visits as well as surveys in writing for a total of 6 months (2012.12.1~2013.5.31). The research comprised of two aspects: system management and R&D project audit. Based on this, we examined current status and problems of the existing system in Korea and made recommendations for improvement. RESULTS: Regulatory objectives and backgrounds of biomedical researches are different from each country due to different characteristics of bioethical oversight system. This shows that each country sets up its own regulations and procedures to fit each situation. Bioethical compliance oversight system greatly varied between the countries. From this study, it can be seen that improvement of existing procedures and oversight system or establishment of new ones are essential in Korea. CONCLUSION: In terms of system management, a dedicated government organization need to be established for bioethical compliance, subject protection, IRB inspection, training, evaluation, and certification of systems, and also support for IRB e-system. Regarding R&D project oversight, it is essential to confirm IRB review results before start of a research, to conduct a review on ethical aspects of research plans, and to carry out continued oversight on bioethical compliance through interim reports.

Effects of Korean Enneagram Program on the Ego-identity, Interpersonal Relationship, and Self-leadership of Nursing College Students / 간호행정학회지

PURPOSE: This study was done to identify the effects of the Korean Enneagram program on college nursing students' ego-identity, interpersonal relationships and self-leadership. METHODS: A nonequivalent control group pre-posttest design was used. Twenty-nine students were in the experimental group receiving the Korean Enneagram program, and 28 were in the control group with no treatment. RESULTS: 'The experimental group will show higher scores for ego-identity (t=3.97, p<.001), interpersonal relationship (t=3.26, p=.002) and self-leadership (t=2.91, p=.007) compared to the control group 8 weeks after the program finished' was supported by significant differences in the scores between the two groups. CONCLUSION: The findings indicate that the Korean Enneagram Program has a significant effect on improving ego-identity, interpersonal skills and self-leadership in nursing college students and the program can be used as a tool to promote the ego-identity, interpersonal skills and self-leadership of nursing students.

Development of a Cultural Competence Scale for Nursing Students

PURPOSE: This methodological study was conducted to develop and test a cultural competence scale for nursing students. METHODS: Based on the five constructs of cultural competency identified in the conceptual analysis of Suh, 76 items for the tool were derived initially. These items were reduced to 58 items after content validity tests (two times) by 6 multicultural experts. Data collected from 526 nursing students were utilized to test the validity and reliability of the preliminary tool. Item analysis, factor analysis, Pearson correlation coefficients, and Cronbach's alpha were used for the analysis. RESULTS: Twenty-seven items were selected for the final scale, and categorized into 5 factors explaining 62.1% of the total variance. Cronbach's alpha was .91 and the reliability of the subscales ranged from .76 to .91. Criterion validity between the developed tool and empathy (r=.26, p <.001) was significant. CONCLUSION: The results show that this scale can provide scientific and empirical data when evaluating the effectiveness of school curriculums or multicultural empowerment programs regarding cultural competence of nursing students.

Stress, Coping Style and Nursing Needs for Hospitalized Pregnant Women due to Preterm Labor

PURPOSE: The purpose of this descriptive study was to assess levels of stress, coping style, and nursing needs for hospitalized pregnant women diagnosed with preterm labor. METHODS: Data were collected from 125 pregnant women aged between 20 and 40 years and diagnosed with preterm labor by OBGY units at 3 hospitals. Data were analyzed by frequency, percentage, t-test, and ANOVA with Scheffe test. RESULTS: The level of stress among women was an average of 2.13 out of 4 points, the level of coping style was an average of 2.66, and nursing needs was an average of 2.83 out of 4 points. The level of stress was significantly different by job, length of hospital stay, type of hospital, and history of admission at obstetric unit. The level of coping style was significantly different by age and monthly income. The level of nursing needs was significantly different by type of hospital. Higher level of stress and coping style were related to higher level of nursing needs. There was no significant correlation between stress and coping style. CONCLUSION: The result showed the importance of nursing intervention dealing with stress, coping style and nursing needs for women with preterm labor. Nurses need to provide nursing interventions to reduce the stress, to strengthen the coping style, and to satisfy the nursing needs for pregnant women hospitalized due to preterm labor.

Adaptation Process of Mothers-in-law of Vietnamese Women Married to Korean Men / 간호행정학회지

PURPOSE: This study was conducted to generate a grounded substantive theory of the adaptation process of mothers-in-law of Vietnamese women married to Korean husbands. METHODS: Thirteen women who had Vietnamese daughters-in-law were interviewed. Data were transcribed verbatim and analyzed using a grounded theory method. RESULTS: Eight categories with 19 sub-categories were extracted from 268 concepts. The identified phenomenon was 'overcoming differences' and the core category was 'trying one's best to live together with daughter-in-law'. The 9 categories were grouped into 3 stages for the adaptation process: encountering, struggling, and living together. CONCLUSION: The results indicate that when individuals from different cultural and personal backgrounds have to live together there is a continuing negotiation process towards meeting each other's needs. Health professionals can assist this adaptation process by providing these women with insights into various ways of meeting each other's need while they are struggling.