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OBJECTIVES: Adipose tissue has been associated with knee osteoarthritis (KOA) pathogenesis, but the longitudinal changes in adipose tissue with KOA progression have not been carefully evaluated. This study aimed to determine if longitudinal changes of systemic and local adipose tissue is associated with radiographic progression of KOA. METHODS: This case-control study used data from the Osteoarthritis Initiative (OAI) and included 315 cases (all the right knees with a minimum of Kellgren-Lawrence score (KL) of 0 and an increase of ≥ 1 KL from baseline to 48 months) and 315 controls matched by age, sex, race, and baseline KL. Cross sectional area of IPFP (IPFP CSA) and subcutaneous adipose tissue around the distal thigh (SCATthigh) were measured using MRI images at baseline and 24 months. Conditional logistic regression models were fitted to estimate associations of obesity markers, IPFP CSA, and SCATthigh with radiographic KOA progression. Mediation analysis was used to assess whether IPFP CSA or SCATthigh mediates the relationships between baseline BMI and radiographic KOA progression. RESULTS: 24-month changes of IPFP CSA (ΔIPFP CSA) and SCATthigh (ΔSCATthigh) were significantly greater in cases compared to controls, whereas Δ BMI and Δ abdominal circumference were similar in both groups during follow-up. Adjusted ORs for radiographic KOA progression were 9.299, 95% CI (5.357-16.141) per 1 SD increase of Δ IPFP CSA and 1.646, 95% CI (1.288-2.103) per 1 SD increase of Δ SCATthigh. ΔIPFP CSA mediated the association between baseline BMI and radiographic KOA progression (87%). CONCLUSIONS: Subjects with radiographic progression of KOA, had significant increases in IPFP CSA and subcutaneous adipose tissue while BMI and abdominal circumference remained stable. Additional studies are needed to confirm these associations.

The objective of this study was to estimate the extent to which motivational regulations influence physical activity behavior through role identity among people 55 years or older. Participants (N = 409; Mage = 66.29 years [SD = 7.06]) completed online questionnaires to measure motivational regulations, role identity, and the frequency of physical activity in a typical week and in the past month. Mediation analysis using ordinary least squares path analysis revealed that autonomous forms of motivational regulation (positively) and controlled forms of motivational regulation (negatively) influenced role identity, which then positively influenced physical activity behavior. Bootstrap confidence intervals (95%) for the indirect effects (a × b) based on 5,000 bootstrap samples were entirely above or below zero. These findings point to future experimental evaluations of interventions aiming at both increasing and decreasing autonomous and controlled motivational regulations, respectively, to promote physical activity behavior through role identity. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine if baseline diabetic retinopathy (DR) severity mediates the relationship between health insurance status and DR progression.DesignRetrospective cohort study.SubjectsSeven hundred sixteen patients aged ≥ 18 years with a diagnosis of type 1 or 2 diabetes mellitus, and a diagnosis of nonproliferative DR (NPDR) were identified from the electronic health record of a tertiary academic center between June 2012 and February 2022.MethodsNPDR severity at baseline was the proposed mediator in the relationship between insurance status and proliferative DR (PDR) progression. Logistic regression was used to determine the association between insurance status and NPDR severity at baseline, and Cox proportional hazards regression was used to assess the association between insurance status and time to PDR progression. To analyze the mediation effect of NPDR severity at baseline, a counterfactual approach, which decomposes a total effect into a natural direct effect and a natural indirect effect was applied.Main outcome measuresTime to progression from first NPDR diagnosis to first PDR diagnosis.ResultsOf the 716 patients, 581 (81%) had Medicare or private insurance, 107 (15%) had Medicaid, and 28 (4.0%) were uninsured at their baseline eye visit. Uninsured or Medicaid patients had a higher proportion of moderate or severe NPDR at their baseline eye visit and a higher proportion of progression to PDR. After adjusting for confounders and NPDR severity at baseline, patients who were uninsured had significantly greater risk of progression to PDR compared with that of patients with Medicare/private insurance (hazard ratio [HR]: 2.63; 95% confidence interval [CI]: 1.10-6.25). Patients with Medicaid also had an increased risk of progression to PDR compared with that of patients with Medicare/private insurance, although not statistically significant (HR: 1.53; 95% CI: 0.81-2.89). NPDR severity at baseline mediated 41% of the effect of insurance status (uninsured vs. Medicare/private insurance) on PDR progression.ConclusionsPatients who were uninsured were more likely to have an advanced stage of NPDR at their baseline eye visit and were at significantly greater risk of progression to PDR compared with patients who had Medicare or were privately insured. Mediation analysis revealed that differences in baseline NPDR severity by insurance explained a significant proportion of the relationship between insurance status and DR progression.Financial disclosuresProprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose: We assessed whether anticipated stigma (i.e., fear of public mistreatment due to gender identity) impacts communication between transgender women (TGW) living with HIV and health care providers. Methods: This is a secondary analysis of baseline data from Trans Amigas, a study conducted in Brazil, 2018. The study population consisted of TGW living with HIV, older than 18 years, residing in the São Paulo metropolitan area. We used multivariable logistic regression (α = 0.05), mediation, and bootstrapping for the analysis. Results: One hundred and thirteen participants completed the study. Fear of public mistreatment had an adjusted odds ratio (aOR) of 7.42 (p = 0.003) for difficulty reporting new symptoms to providers. Concerning fear of public mistreatment, we found that unemployment had an aOR of 3.62 (p = 0.036); sex work, an aOR of 2.95 (p = 0.041); and issues related to name change in documents, an aOR of 2.71 (p = 0.033). For the indirect effect on difficulty reporting new symptoms, mediated by fear of public mistreatment, unemployment had an aOR of 1.52 (confidence interval [CI] = 0.88-2.24); sex work, an aOR of 1.48 (CI = 0.81-2.52); and name change issues, an aOR of 1.47 (CI = 0.96-2.43). Conclusions: Anticipated stigma was associated with communication difficulties between TGW living with HIV and providers. Our data suggest that structural factors associated with anticipated stigma could indirectly impact on difficulty reporting new symptoms. These findings indicate the importance of considering social contexts that intersect with individual experiences when analyzing communication barriers between providers and patients, and the need to strengthen social policies for TGW in Brazil. Clinical Trial Registration number: R34MH112177.

Root-associated microbiomes in the rhizosphere (rhizobiomes) are increasingly known to play an important role in nutrient acquisition, stress tolerance, and disease resistance of plants. However, it remains largely unclear to what extent these rhizobiomes contribute to trait variation for different genotypes and if their inclusion in the genomic selection protocol can enhance prediction accuracy. To address these questions, we developed a microbiome-enabled genomic selection method that incorporated host SNPs and amplicon sequence variants from plant rhizobiomes in a maize diversity panel under high and low nitrogen (N) field conditions. Our cross-validation results showed that the microbiome-enabled genomic selection model significantly outperformed the conventional genomic selection model for nearly all time-series traits related to plant growth and N responses, with an average relative improvement of 3.7%. The improvement was more pronounced under low N conditions (8.4-40.2% of relative improvement), consistent with the view that some beneficial microbes can enhance N nutrient uptake, particularly in low N fields. However, our study could not definitively rule out the possibility that the observed improvement is partially due to the amplicon sequence variants being influenced by microenvironments. Using a high-dimensional mediation analysis method, our study has also identified microbial mediators that establish a link between plant genotype and phenotype. Some of the detected mediator microbes were previously reported to promote plant growth. The enhanced prediction accuracy of the microbiome-enabled genomic selection models, demonstrated in a single environment, serves as a proof-of-concept for the potential application of microbiome-enabled plant breeding for sustainable agriculture.

BackgroundObesity influences the development of osteoarthritis via low-grade inflammation. Progression of local inflammation (= synovitis) increased with weight gain in overweight and obese women compared to stable weight. Synovitis could be associated with subcutaneous fat (SCF) around the knee. Purpose of the study was to investigate the effect of weight loss on synovitis progression and to assess whether SCF around the knee mediates the relationship between weight loss and synovitis progression.MethodsWe included 234 overweight and obese participants (body mass index [BMI] ≥ 25 kg/m2) from the Osteoarthritis Initiative (OAI) with > 10% weight loss (n = 117) or stable overweight (

Background: Including structural determinants (e.g. criminalisation, stigma, inequitable gender norms) in dynamic HIV transmission models is important to help quantify their population-level impacts and guide implementation of effective interventions that reduce the burden of HIV and inequalities thereof. However, evidence-based modelling of structural determinants is challenging partly due to a limited understanding of their causal pathways and few empirical estimates of their effects on HIV acquisition and transmission. Methods: We conducted a scoping review of dynamic HIV transmission modelling studies that evaluated the impacts of structural determinants, published up to August 28, 2023, using Ovid Embase and Medline online databases. We appraised studies on how models represented exposure to structural determinants and causal pathways. Building on this, we developed a new methodological framework and recommendations to support the incorporation of structural determinants in transmission dynamics models and their analyses. We discuss the data and analyses that could strengthen the evidence used to inform these models. Results: We identified 17 HIV modelling studies that represented structural determinants and/or interventions, including incarceration of people who inject drugs (number of studies [n] = 5), violence against women (n = 3), HIV stigma (n = 1), and housing instability (n = 1), among others (n = 7). Most studies (n = 10) modelled exposures dynamically. Almost half (8/17 studies) represented multiple exposure histories (e.g. current, recent, non-recent exposure). Structural determinants were often assumed to influence HIV indirectly by influencing mediators such as contact patterns, condom use, and antiretroviral therapy use. However, causal pathways' assumptions were sometimes simple, with few mediators explicitly represented in the model, and largely based on cross-sectional associations. Although most studies calibrated models using HIV epidemiological data, less than half (7/17) also fitted or cross-validated to data on the prevalence, frequency, or effects of exposure to structural determinants. Conclusions: Mathematical models can play a crucial role in elucidating the population-level impacts of structural determinants and interventions on HIV. We recommend the next generation of models reflect exposure to structural determinants dynamically and mechanistically, and reproduce the key causal pathways, based on longitudinal evidence of links between structural determinants, mediators, and HIV. This would improve the validity and usefulness of predictions of the impacts of structural determinants and interventions. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic induced psychological distress, which is linked to emotional eating and symptoms of addiction to ultra-processed foods (UPFs). Objective: This study aimed to investigate whether symptoms of addiction to UPFs mediate the relationship between psychological stress due to the COVID-19 pandemic and emotional eating behaviour. Methods: A cross-sectional online study was conducted from May to November 2021 among 368 undergraduate Brazilian students. The participants answered demographic questions and completed validated scales, including the Coronavirus Stress Measure, Modified Yale Food Addiction Scale 2.0 and Emotional Eating Questionnaire. Mediation analysis was employed to examine the hypothesised relationships. Results: The results revealed a significant indirect effect, indicating that symptoms of food addiction mediated the association between perceived stress during the COVID-19 pandemic and emotional eating behaviour. Specifically, 61% of the influence of perceived stress on emotional eating during the pandemic was explained by symptoms of UPF addiction. Conclusion: These findings suggest that addressing symptoms of UPF addiction could be pivotal in public health strategies aimed at promoting healthy eating habits among distressed undergraduate students in the post-COVID-19 era. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusions Although the benefits of doula care during childbirth are well‐known, its impact on childbirth‐related post‐traumatic stress disorder (CB‐PTSD) symptoms are less thoroughly characterized. This study aimed to explore the association between doula care and CB‐PTSD symptoms and the potential mediating role of childbirth experience on this association.A prospective cohort study was conducted in a hospital in China, enrolling women with singleton live vaginal births. The exposure and primary outcome factors of interest were doula care and CB‐PTSD symptoms, with childbirth experience as a mediating factor. Questionnaires were administered to collect baseline data and childbirth experience at 3 days postpartum, and CB‐PTSD symptoms from participants at 42 days postpartum. Linear regression analysis was used to analyze the relationship between doula care, childbirth experience, and CB‐PTSD symptoms, while the mediating role of childbirth experience was analyzed using the SPSS (PROCESS) modeling tool.A total of 445 eligible women were included in the final analysis, including 120 who received doula care and 325 who did not. Linear regression analyses found that doula care was independently associated with CB‐PTSD symptoms (β = −0.11, p < 0.05) and childbirth experience (β = 0.50, p < 0.001). Childbirth experience was significantly associated with CB‐PTSD symptoms (β = −0.17, p < 0.001). Childbirth experience mediated the association between doula care and CB‐PTSD symptoms (indirect effect = −1.08, 95% CI −1.91 to −0.10), even after adjusting for potential confounders.Childbirth experience serves as a mediator of the association between doula care and CB‐PTSD symptoms. By providing supportive care for women during childbirth, their childbirth experience could be improved, thereby reducing the risk of CB‐PTSD symptoms. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence indicates a close relationship between alterations in human immune cells and plasma metabolites with Rheumatoid Arthritis (RA). However, limited studies have left the causal relationships behind these links unclear. Methods: A bidirectional Mendelian Randomization (MR) study was conducted, combined with mediation analysis, using data from genome-wide association study database covering 731 immune cell phenotypes and 1,400 plasma metabolite traits to explore their causal relationships with RA and potential mediating effects. The primary method used for MR analysis was inverse-variance weighted and False Discovery Rate (FDR) correction was applied to verify the robustness of our results. Results: HLA DR on CD33- HLA DR+ (myeloid cell group) (OR, 1.422; 95% CI, 1.194-1.694; P < 0.001; PFDR = 0.012) increased the risk of developing RA. CD19 on IgD+ CD38- naive (B cell group) (OR, 0.969; 95% CI, 0.954-0.985; P < 0.001; PFDR = 0.021) reduced the risk of developing RA. RA was a risk factor for HLA DR on CD14- CD16+ monocytes (monocyte group) (OR, 1.242; 95% CI, 1.102-1.401; P < 0.001; PFDR = 0.047). RA was a protective factor for memory B cell % lymphocyte (B cell group) (OR, 0.861; 95% CI, 0.795-0.933; P < 0.001; PFDR = 0.050), CD4+ CD8dim T cell %lymphocyte (TBNK group) (OR, 0.802; 95% CI, 0.711-0.904; P < 0.001; PFDR = 0.043), CD4+ CD8dim T cell %leukocyte (TBNK group) (OR, 0.814; 95% CI, 0.726-0.913; P < 0.001; PFDR = 0.046), CD24 on IgD+ CD24+ B cells (B cell group) (OR, 0.857; 95% CI, 0.793-0.927; P < 0.001; PFDR = 0.038), and CD24 on unswitched memory B cells (B cell group) (OR, 0.867; 95% CI, 0.797-0.942; P < 0.001; PFDR = 0.050). Increasing levels of docosatrienoate (22:3n3) (OR, 0.886; 95% CI, 0.838-0.936; P < 0.001; PFDR = 0.023) significantly reduced the risk of developing RA. The mediating effect of plasma metabolites in this context was not established. Conclusion: This study provides genetic evidence for the intricate relationships between immune cells, plasma metabolites, and RA, highlighting the potential mechanisms involved. This will contribute to future directions in precision medicine and research. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the association between heavy metal exposure and the prevalence of depression, with the mediating role of sleep duration. Method: Our study investigated the association between heavy metal concentration and depression risk in the NHANES from 2005 to 2020. We used logistic regression analysis, WQS regression model and BKMR model to assess the association. Mediation analysis was performed to explore the role of sleep duration in heavy metal exposure-induced depression. Result: Of the 10,825 individuals included in this study, 705 (6.85%) were diagnosed with depression. We found a positive association between the cadmium (Cd), cobalt (Co), lead (Pb), antimony (Sb), wolfram (W) concentration and the prevalence of depression. Moreover, heavy metals mixtures were positively correlated with the prevalence of depression, with Cd identified as the main contributor in the WQS regression model (0.4654). Furthermore, sleep duration mediated the association between Cd, molybdenum (Mo), Pb, Sb, W exposure and prevalence of depression, explaining 3.12%, 15.84%, 18.24%, 9.56%, 3.68% of the effect. Conclusion: The findings affirm that heavy metal exposure is linked to higher depression incidence and that this relationship is partly mediated by sleep duration alterations. The study underscores the importance of environmental health monitoring and interventions aimed at reducing heavy metal exposure to mitigate its psychological impacts. [ABSTRACT FROM AUTHOR]

Background: Exploring the impact of professional identity on the academic performance of nursing students is crucial for understanding how to improve educational outcomes in this field. Professional identity not only shapes students' self-concept but also influences their motivation, commitment, and success in their studies. However, the mechanisms underlying this relationship are not fully elucidated. This study aims to examine the potential mediating roles of general self-efficacy and learning engagement in this relationship. Methods: A total of 1097 Chinese nursing students participated in this study. They were assessed using the Professional Identity Questionnaire for Undergraduate Students, the General Self-Efficacy Scale, the Utrecht Work Engagement Scale for Students, and the College Students Academic Achievement Scale. The data were analyzed using Pearson correlation, structural equation modeling, and deviation-corrected percentile bootstrap techniques. Results: (1) Professional identity (PI) was positively correlated with academic achievement (AA)(r = 0.446, P < 0.01), and the direct path of professional identity on academic achievement was significant (β = 0.301, t = 19.816, P < 0.001). (2) Professional identity positively predicted general self-efficacy(GSE) (β = 0.183, t = 16.427, P < 0.001) and learning engagement(LE) (β = 0.640, t = 22.494, P < 0.001). GSE positively predicted LE(β = 0.645, t = 9.320, P < 0.001) and AA(β = 0.458, t = 12.376, P < 0.001). LE positively predicted AA (β = 0.169, t = 10.877, P < 0.001). (3) GSE and LE play a significant mediating role between PI and AA. The mediating effect includes three paths: PI→GSE→AA(the mediating effect value: 0.084) and PI→LE→AA (the mediating effect value: 0.108). PI→GSE→LE→AA (the mediating effect value: 0.020). Conclusion: Professional identity exerts both direct and indirect influences on the academic achievement of nursing students, mediated through general self-efficacy and learning engagement. These findings underscore the importance of nurturing professional identity as a strategic approach to enhancing academic success in nursing education, providing a foundation for targeted interventions that foster personal and academic growth. [ABSTRACT FROM AUTHOR]

Despite a large body of research exploring the influence of adolescent bullying victimization on a range of outcomes such as gun possession, scholars know less about the factors driving these relationships. Grounded in Agnew’s general strain theory, this study investigated whether the influence of bullying victimization on gun carrying behaviors operates indirectly through depressive symptoms. To answer this question, this study used data collected from a statewide representative sample of 9,819 middle and high school students who participated in the 2019 Florida Youth Substance Abuse Survey. Net of other potential confounding influences including race, age, sex, and level of parental education, results from the analyses indicate bullying victimization increased the odds that a respondent carries a gun. When a measure of depressive symptoms was added to the model, however, the bullying victimization variable dropped to non-significance, thus suggesting bullying victimization increased one’s depressive symptoms, which, in turn, increased the odds a respondent carried a gun. Furthermore, results from a Karlson – Holm – Breen (KHB) decomposition analysis revealed this indirect effect was statistically significant. The results from this study provide parents, teachers, and policymakers with information to help address issues associated with bullying and gun carrying behaviors among adolescents. [ABSTRACT FROM AUTHOR]

Background: Psychiatric nurses face additional challenges due to negative perceptions, workplace violence, and a lack of respect, impacting their well-being and job satisfaction, which are crucial for improving psychiatric care and patient outcomes. Objectives: This study aims to examine the relationship between effort-reward imbalance, well-being, burnout, and decent work among psychiatric nurses. Methods: This study used a cross-sectional design. Data were collected using a convenience sampling method in February 2024 from 397 psychiatric nurses at two psychiatric hospitals in Hangzhou and Huzhou, Zhejiang Province. The Effort-Reward Imbalance Scale, Decent Work Perception Scale, Maslach Burnout Inventory-General Survey, and General Well-Being Schedule Scale were used for data collection. Data analysis was conducted using SPSS 26.0 and the PROCESS macro. Results: The study found that effort-reward imbalance among psychiatric nurses was negatively correlated with decent work (r = -0.564, p < 0.001) and well-being (r = -0.541, p < 0.001), and positively correlated with burnout (r = 0.603, p < 0.001). Burnout mediated the relationship between effort-reward imbalance and well-being (95% CI [-0.386, -0.257]), while decent work also served as a mediator (95% CI [-0.100, -0.012]). Additionally, burnout and decent work were found to mediate the relationship between effort-reward imbalance and well-being (95% CI [-0.050, -0.006]). Conclusion: This study highlights the impact of effort-reward imbalance on well-being, confirming that burnout and decent work serve as mediators. Enhancing support, fair compensation, reasonable work schedules, and professional development can promote psychiatric nurses' perception of decent work and improve their well-being. [ABSTRACT FROM AUTHOR]

The positive mindfulness-creativity link has been widely documented; however, its underlying psychological mechanisms remain less understood. From the perspective of positive psychology, this study examined the mediating effect of psychological capital (PsyCap) on the effect of dispositional mindfulness on creative functioning. A total of 894 Chinese secondary school students in Hong Kong (50.8% female; Mage = 15.5 years) completed the study. A cross-sectional design was used, in which context PsyCap and dispositional mindfulness were assessed by the Chinese version of the revised Compound PsyCap Scale (CPC-12R) and the Mindful Attention Awareness Scale (MAAS), respectively. Moreover, by adopting the multiple-measurement approach to creativity, three commonly used creativity tests (i.e., theWallach-KoganCreativity Test/WKCT, the Test for Creative Thinking-Drawing Production/TCT-DP, and the Creative Problem-Solving Test/CPST) were applied to capture three aspects of creativity (i.e., divergent thinking, creative combination, and creative problem solving). The results suggest that (1) PsyCap partially but significantly mediated the mindfulness-creativity link for all three aspects of creative functioning, and (2) PsyCap demonstrated the strongest effect size in mediating the mindfulness-creativity link for creative problem solving, followed by creative combination and then divergent thinking. These results, on the one hand, support the positive psychology perspective by confirming a positive psychological resource mechanism regarding the relationship between mindfulness and creativity. On the other hand, the results regarding the varied sizes of the mediation effect further enrich the discourse on this perspective by showing that the mediation mechanism may function to different degrees depending on which aspect of creativity is under consideration. These findings illuminate the positive functioning of mindfulness, psychological resources/capital and creativity. [ABSTRACT FROM AUTHOR]

Background: We aimed to use lactate dehydrogenase (LDH) as a marker of inflammation burden and quantify post-stroke inflammation's direct and indirect effect on functional disability. Methods: We analyzed 5,129 patients with acute ischemic stroke (AIS) admitted to Shenyang First People's Hospital. Stroke recurrence and functional outcome measured by the modified Rankin Scale (mRS) were assessed at 90 days. Functional disability was defined as mRS score > 2. Receiver operating characteristic curve and restricted cubic spline (RCS) analysis were conducted to illustrate the associations between LDH levels and 90-day functional outcomes in patients with AIS. Mediation analyses were performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between LDH and functional outcome. Positive correlation between LDH and hs-CRP was found and mediation effects of stroke recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results. Results: Among 5,129 included AIS patients, the median (IQR) level of LDH was 186 (161-204.4) U/L. Functional disability was seen in 1200 (23.4%) patients and recurrence was observed in 371(7.2%) patients at 90-day follow-up. Each standard deviation increase in the concentration of LDH was linked to an increased risk of functional disability (adjusted odds ratio[aOR], 1.07; 95%CI,1.04-1.09) and stroke recurrence (aOR,1.02; 95%CI, 1.01-1.04) within 90 days. The highest quartile of LDH (>204.2 U/L) had an elevated risk of suffering functional disability (aOR, 1.21; 95%CI, 1.00-1.47) and recurrence (aOR, 1.21; 95%CI,1.00-1.47) compared with the lowest quartile of LDH (<161 U/L). Stroke recurrence during follow-up explained 12.90% (95%CI, 6.22-21.16%) of the relationship between LDH and functional disability. Positive correlation between LDH and hs-CRP was found and mediation effects of recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results. Conclusion: The relationship between LDH and functional disability at 90 days among AIS patients is partially mediated by stroke recurrence, accounting for less than 20%. LDH deserves equal attention as hs-CRP in predicting recurrence and functional outcome. In addition to traditional secondary prevention measures, innovative anti-inflammatory strategies warrant further investigation. [ABSTRACT FROM AUTHOR]

ABSTRACT A mediation analysis approach is proposed for multiple exposures, multiple mediators, and a continuous scalar outcome under the linear structural equation modeling framework. It assumes that there exist orthogonal components that demonstrate parallel mediation mechanisms on the outcome, and thus is named principal component mediation analysis (PCMA). Likelihood‐based estimators are introduced for simultaneous estimation of the component projections and effect parameters. The asymptotic distribution of the estimators is derived for low‐dimensional data. A bootstrap procedure is introduced for inference. Simulation studies illustrate the superior performance of the proposed approach. Applied to a proteomics‐imaging dataset from the Alzheimer's disease neuroimaging initiative (ADNI), the proposed framework identifies protein deposition – brain atrophy – memory deficit mechanisms consistent with existing knowledge and suggests potential AD pathology by integrating data collected from different modalities. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the impact of the COVID-19 pandemic on non-suicidal self-injury (NSSI) among youth students, and the mediating role of psychological factors in the relationship between the COVID-19 pandemic and NSSI. Method: An online survey was conducted at junior and senior high schools, as well as universities located in Jingzhou, Hubei Province, China between June 2021 and January 2022. The COVID-19 Impact Index was constructed using multiple correspondence analysis (MCA) method. The bootstrapping method was used for mediation analysis. Results: A total of 16025 youth participated in the study and 12507 youth (78.1%) finished the questionnaires. The COVID-19 Impact Index had a significantly positive effect on NSSI (r=0.16, p<0.001). The mediation analysis results showed that the COVID-19 Impact Index had a significant indirect effect on youth' NSSI (b=0.0918, 95% CI [0.0788, 0.1048]), and this indirect effect was mainly achieved through affecting youth' anxiety, depression and post-traumatic stress disorder (PTSD). The mediation effect of anxiety on NSSI was 0.0584, the direct effect was 0.0334, and the mediation proportion was 63.6%. The mediation effect of depression on NSSI was 0.0668, the direct effect was 0.0250, and the mediation proportion was 72.8%. The mediation effect of PTSD on NSSI was 0.0640, the direct effect was 0.0278, and the mediation proportion was 69.7%. All the mediation effects, direct effects and total effects were statistically significant (p<0.001). Conclusion: The higher the impact of the COVID-19 Impact Index, the higher the prevalence of NSSI among youth students. Anxiety, depression and PTSD had mediated the relationship between the COVID-19 Impact Index and NSSI. It is suggested that specific health policies, mental health services and interventions should be developed to reduce the NSSI and improve mental health status among youth students during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: This longitudinal study aimed to investigate the causal relationship between physical exercise and emotional states among university students, focusing on the mediating role of sense of coherence. Method: A total of 1,215 university students (aged 18-25 years) were recruited and completed questionnaires assessing physical activity (International Physical Activity Questionnaire-Short Form), emotional states (Positive and Negative Affect Schedule), and sense of coherence (Sense of Coherence Scale-13) at three time points over a three-month period. Preliminary analyses included independent samples t-tests, chi-square tests, and Pearson correlations. Cross-lagged panel mediation analysis was conducted using Mplus 8.3, with bootstrapping employed to test indirect effects. Results: Results indicated that sense of coherence significantly predicted positive affect (β = 0.259-0.369, p < 0.001). Positive affect, in turn, predicted physical exercise (β = 0.083-0.182, p < 0.05), while negative affect also influenced physical exercise (β = -0.096-0.203, p < 0.05). Physical exercise indirectly influenced positive affect through sense of coherence (β = 0.037, p = 0.045), and positive affect indirectly influenced physical exercise through sense of coherence (β = 0.029, p = 0.028). Other indirect effects involving physical exercise, sense of coherence, and negative affect were non-significant. Conclusion: This study underscores the importance of sense of coherence in promoting emotional well-being among university students and in the reciprocal relationship between physical exercise and positive emotional states. Findings suggest that interventions targeting sense of coherence may enhance the emotional benefits of physical exercise. Future research should explore other potential mediators and moderators of the relationship between physical exercise and emotions and examine the effectiveness of sense of coherence-based interventions on well-being in this population. [ABSTRACT FROM AUTHOR]

Background: Psychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied. Methods: We used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0–24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD. Results: Regression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0–47.3%), 13.7% (95% CI: 8.2–19.3%), and 10.5% (95% CI: 8.0–13.0%), respectively; consequently increasing PD between 50 and 75 years. Conclusion: The results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions Non‐invasive diagnostics for metabolic dysfunction–associated fatty liver disease (MAFLD) remain challenging. We aimed to identify novel key genes as non‐invasive biomarkers for MAFLD, elucidate causal relationships between biomarkers and MAFLD and determine the role of immune cells as potential mediators.Utilizing published transcriptome data of patients with biopsy‐proven MAFLD, we applied linear models for microarray data, least absolute shrinkage and selector operation (LASSO) regressions and receiver operating characteristic (ROC) curve analyses to identify and validate biomarkers for MAFLD. Using the expression quantitative trait loci database and a cohort of 778 614 Europeans, we used Mendelian randomization to analyse the causal relationships between key biomarkers and MAFLD. Additionally, mediation analysis was performed to examine the involvement of 731 immunophenotypes in these relationships.We identified 31 differentially expressed genes, and LASSO regression showed three hub genes, IGFBP2, PEG10, and P4HA1, with area under the receiver operating characteristic (AUROC) curve of 0.807, 0.772 and 0.791, respectively, for identifying MAFLD. The model of these three genes had an AUROC of 0.959 and 0.800 in the development and validation data sets, respectively. This model was also validated using serum‐based enzyme‐linked immunosorbent assay data from MAFLD patients and control subjects (AUROC: 0.819, 95% confidence interval: 0.736–0.902). PEG10 was associated with an increased MAFLD risk (odds ratio = 1.106, p = 0.032) via inverse variance–weighted analysis, and about 30% of this risk was mediated by the percentage of CD11c + CD62L– monocytes.The MAFLD panels have good diagnostic accuracy, and the causal link between PEG10 and MAFLD was mediated by the percentage of CD11c + CD62L– monocytes. [ABSTRACT FROM AUTHOR]

Background: With the rapid implementation of enhanced recovery after surgery, most gynecological patients are discharged without full recovery. Discharge planning is necessary for patients and their families to transition from hospital to home. Discharge teaching and discharge readiness are two core indicators used to evaluate the quality of discharge planning, which impacts the post-discharge outcomes. To improve post-discharge outcomes, the interaction mechanism of the three variables needs to be determined, but few studies have focused on it. Objectives: Explore the mediating effect of discharge readiness between discharge teaching and post-discharge outcomes of gynecological inpatients. Methods: Discharge teaching and discharge readiness were measured by the Quality of Discharge Teaching Scale (QDTS) and Readiness for Hospital Discharge Scale (RHDS). Post-discharge outcomes on postoperative Day 7 (POF-D7) and postoperative Day 28 (POF-D28) were measured by a self-designed tool. Spearman correlations, Kruskal‒Wallis tests and Mann‒Whitney U tests were conducted to explore the correlation between post-discharge outcomes and other variables. Mediation analysis was used to explore the mediating effect of discharge readiness between discharge teaching and post-discharge outcomes. Results: QDTS and RHDS showed strong positive correlations with post-discharge outcomes. The mediation analyses verified that RHDS was a full mediator between QDTS and POF-D7, and the indirect effect accounted for 95.6% of the total direct effect. RHDS was a partial mediator between QDTS and POF-D28, and the indirect effect accounted for 50.0% of the total direct effect. RHDS was a full mediator between QDTS and total scores of post-discharge outcomes, and the indirect effect accounted for 88.9% of the total direct effect. Conclusions: Discharge teaching can improve the post-discharge outcomes of gynecological inpatients through the intermediary role of discharge readiness. Doctors and nurses should value the quality of discharge teaching and the discharge readiness improving of gynecological inpatients. Future studies should note the interaction mechanism of the three variables to explore more efficient ways of improving post-discharge outcomes of gynecological inpatients. [ABSTRACT FROM AUTHOR]

Causal effect estimation from observational data is one of the essential problems in causal inference. However, most estimation methods rely on the strong assumption that all confounders are observed, which is impractical and untestable in the real world. We develop a mediation analysis framework inferring the latent confounder for debiasing both direct and indirect causal effects. Specifically, we introduce generalized structural equation modeling that incorporates structured latent factors to improve the goodness-of-fit of the model to observed data, and deconfound the mediators and outcome simultaneously. One major advantage of the proposed framework is that it uses the causal pathway structure from cause to outcome via multiple mediators to debias the causal effect without requiring external information on latent confounders. In addition, the proposed framework is flexible in terms of integrating powerful nonparametric prediction algorithms while retaining interpretable mediation effects. In theory, we establish the identification of both causal and mediation effects based on the proposed deconfounding method. Numerical experiments on both simulation settings and a normative aging study indicate that the proposed approach reduces the estimation bias of both causal and mediation effects. for this article are available online. [ABSTRACT FROM AUTHOR]

Introduction: Treating plaque psoriasis (PsO) with guselkumab (GUS) promotes skin clearance and is associated with improvements in health-related quality of life (HRQoL), anxiety, and depression. It is unclear whether improvements in patient-reported outcomes are due to resolution of skin symptoms or the direct result of GUS treatment. Methods: Two phase 3, placebo- and active-comparator-controlled studies randomized patients with moderate-to-severe PsO to GUS, placebo (crossing over to GUS at week 16), or adalimumab. Post hoc mediation analyses examined direct and indirect effects of GUS, versus adalimumab, on Dermatology Life Quality Index (DLQI) or Hospital Anxiety and Depression Scale (HADS) after adjusting for indirect effects mediated by skin clearance, evaluated via Psoriasis Area and Severity Index (PASI), to determine the direct effect of GUS on dermatology HRQoL, depression, and anxiety. Results: Compared with adalimumab, the natural direct effect (NDE) of GUS on change in DLQI from baseline was − 2.04 (P < 0.001), using PASI improvement as a mediator, indicating 89.2% of the total treatment effect was due to direct effects of GUS; using PASI 90 as a mediator, NDE of GUS was − 1.43 (P < 0.001), with 62.2% of the total treatment effect attributed to direct effects of GUS. Compared with adalimumab, 25.5% of change in HADS anxiety score was mediated through PASI improvement (NDE − 0.74; P = 0.002), indicating 74.5% of the total effect was independent of PASI improvement. Similarly, 24% of treatment effect was mediated through PASI 90 (NDE − 0.76; P = 0.002). Comparable proportions of the total improvement in HADS depression scores were due to direct and indirect effects of GUS mediated through PASI improvement (direct, 50.2%; indirect, 49.8%) or PASI 90 (direct, 59.5%; indirect, 40.5%). Conclusions: GUS-mediated improvements in anxiety, depression, and overall HRQoL are not solely mediated by resolution of PsO signs, suggesting GUS use has a potential direct effect on anxiety and depression. [ABSTRACT FROM AUTHOR]

Knowledge is needed regarding mechanisms acting between physical activity (PA) and chronic pain. We investigated whether cold pain tolerance mediates an effect of leisure-time physical activity on the risk of chronic pain 7 to 8 years later using consecutive surveys of the population-based Tromso Study. We included participants with information on baseline leisure-time PA (LTPA) and the level of cold pressor-assessed cold pain tolerance, who reported chronic pain status at follow-up as any of the following: chronic pain for ≥3 months, widespread chronic pain, moderate-to-severe chronic pain, or widespread moderate-to-severe chronic pain. We included 6834 participants (52% women; mean age, 55 years) in counterfactual mediation analyses. Prevalence decreased with severity, for example, 60% for chronic pain vs 5% for widespread moderate-to-severe chronic pain. People with one level higher LTPA rating (light to moderate or moderate to vigorous) at baseline had lower relative risk (RR) of 4 chronic pain states 7 to 8 years later. Total RR effect of a 1-level LTPA increase was 0.95 (0.91-1.00), that is, -5% decreased risk. Total effect RR for widespread chronic pain was 0.84 (0.73-0.97). Indirect effect for moderate-to-severe chronic pain was statistically significant at RR 0.993 (0.988-0.999); total effect RR was 0.91 (0.83-0.98). Statistically significantly mediated RR for widespread moderate-to-severe chronic pain was 0.988 (0.977-0.999); total effect RR was 0.77 (0.64-0.94). This shows small mediation of the effect of LTPA through pain tolerance on 2 moderate-to-severe chronic pain types. This suggests pain tolerance to be one possible mechanism through which PA modifies the risk of moderate-to-severe chronic pain types with and without widespread pain. [ABSTRACT FROM AUTHOR]

• Repeated-measure design in workers exposed to chromate was conducted. • Blood chromium was positively correlated with liver enzyme levels and bilirubin levels, suggesting that chromate exposure may cause liver injury. • Blood chromium was positively correlated with systemic inflammatory markers PLT and PLR, suggesting that chromate exposure may lead to increased systemic inflammation. • Systemic inflammatory markers PLT and PLR mediate the increase of liver enzymes and bilirubin induced by chromium exposure, with the mediating ratio ranging from 8.26% to 15.58%. Hexavalent chromium and its compounds are prevalent pollutants, especially in the work environment, pose a significant risk for multisystem toxicity and cancers. While it is known that chromium accumulation in the liver can cause damage, the dose-response relationship between blood chromium (Cr) and liver injury, as well as the possible potential toxic mechanisms involved, remains poorly understood. To address this, we conducted a follow-up study of 590 visits from 305 participants to investigate the associations of blood Cr with biomarkers for liver injury, including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and direct bilirubin (DBIL), and to evaluate the mediating effects of systemic inflammation. Platelet (PLT) and the platelet-to-lymphocyte ratio (PLR) were utilized as biomarkers of systemic inflammation. In the linear mixed-effects analyses, each 1-unit increase in blood Cr level was associated with estimated effect percentage increases of 0.82% (0.11%, 1.53%) in TBIL, 1.67% (0.06%, 3.28%) in DBIL, 0.73% (0.04%, 1.43%) in ALT and 2.08% (0.29%, 3.87%) in AST, respectively. Furthermore, PLT mediated 10.04%, 11.35%, and 10.77% increases in TBIL, DBIL, and ALT levels induced by chromate, respectively. In addition, PLR mediated 8.26% and 15.58% of the association between blood Cr and TBIL or ALT. These findings shed light on the mechanisms underlying blood Cr-induced liver injury, which is partly due to worsening systemic inflammation. [Display omitted] [ABSTRACT FROM AUTHOR]

Information and cue-taking research suggests that given most citizens lack knowledge of and interest in politics, people rely on cues from political parties or social groups to decide their opinions on issues. Using a survey experiment conducted in Taiwan regarding nuclear energy, we rigorously examine the effect of information on direct democracy. Further, based on appraisal theories I suppose that information as stimuli may trigger emotion if there is significant policy inference from information. This study estimates a causal mediation effect of information on voting intention through emotion. The central finding is that receiving more relevant information triggers emotion, which in turn makes individuals in such circumstance much more likely to express their voice (i.e. participate in the referendum). [This study echoes] the information research: party-cue or group-influence is not a necessary condition for people to accept new information and behave accordingly. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the potential mediating role of the neurofilament light chain (NfL) level between depressive symptoms and cognitive function in older population. A total of 495 adults (age ≥60 years) from the National Health and Nutrition Examination Survey (NHANES) participated in this study. Cognitive function was assessed using a combination of the Animal Fluency Test (AFT), the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and the Digit Symbol Substitution Test (DSST). Word List Learning Test. Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Data on serum NfL(sNfL) were collected. Multiple linear regressions and mediation analysis were utilized to examine the associations. After adjusting for potential confounding factors, the proportions mediated by the sNfL level between depressive symptoms and cognitive function was 19.65 %. The indirect effect mediated by the sNfL level between depressive symptoms and cognitive function was significant (β [95 % CI]:-0.0089 [−0.0191, −0.0017], p = 0.040), while the direct effect in the absence of sNfL was non-significant (β [95 % CI]: −0.0365 [−0.0739 0.0008], p = 0.055). This is an explorative cross-sectional study with its limits in generalizability and ability to establish definitive causal associations. The results should be interpreted with caution due to the constraints imposed by the characteristics of the population with a relatively low overall level of depressive symptoms. The sNfL level, depressive symptoms, and cognitive decline are interconnected, and the sNfL level could mediate the relationship between depressive symptoms and cognitive decline among older adults. • Depression symptoms were associated with cognitive decline. • The sNfL level may mediate the association between depression and cognition. • It might be important to monitor and address sNfL levels in older adults with depressive symptoms [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) is the main condition related to perinatal morbimortality worldwide. The aim of this study was to determine the indirect effects of neighbourhood socioeconomic status (NSES) on the risk of spontaneous PTB. Methods: We carried out a retrospective case-control study including sociodemographic and obstetric data of multigravid women who gave birth at a maternity hospital in Tucumán, Argentina, between 2005 and 2010: 949 women without previous PTB nor pregnancy loss who delivered at term and 552 who had spontaneous PTB. NSES was estimated from the Unsatisfied Basic Needs index of census data. Variables selected through penalised regressions were used to create a data-driven Bayesian network; then, pathways were identified and mediation analyses performed. Results: Maternal age less than 20 years mediated part of the protective effect of high NSES on spontaneous PTB [natural indirect effect (NIE) -0.0125, 95% confidence interval (CI) (-0.0208, -0.0041)] and on few prenatal visits (< 5) [NIE − 0.0095, 95% CI (-0.0166, -0.0025)]. These pathways showed greater sensitivity to unobserved confounders that affect the variables mediator-outcome in the same direction, and exposure-mediator in the opposite direction. They did not show sensitivity to observed potential confounders, nor to the parameterization used to define NSES. Meanwhile, urinary tract infections showed a trend in mediating the effect of low NSES on spontaneous PTB [NIE 0.0044, 95% CI (-0.0006, 0.0093), P 0.0834]. Conclusions: High NSES has protective indirect effects on spontaneous PTB risk, mainly associated with a lower frequency of teenage pregnancy. Significance: Few studies have empirically investigated pathways between neighbourhood socioeconomic status (NSES) and specific individual-level traits on spontaneous preterm birth, especially in Latin American populations. The findings of this study suggest that high NSES has protective indirect effects on spontaneous preterm birth, mainly associated with a lower frequency of teenage pregnancy. [ABSTRACT FROM AUTHOR]

Introduction Mechanisms underlying kidney benefits with sodium-glucose cotransporter-2 (SGLT2) inhibition in heart failure and/or type 2 diabetes (T2D) with established cardiovascular disease are currently unclear. Methods We evaluated post hoc the factors mediating the effect of empagliflozin on a composite kidney outcome (first sustained estimated glomerular filtration rate ≥40% reduction from baseline, initiation of renal replacement therapy or death due to kidney disease) in EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients). Variables, calculated as change from baseline or updated mean, were evaluated as time-dependent covariates and using a landmark approach (at Week 12) in Cox regression analyses. In multivariable analyses, variables with the greatest mediating effect were added using a step-up procedure. Results In univariable time-dependent updated mean covariate analyses, the strongest mediator was hematocrit (99.5% mediation). Hemoglobin, uric acid and urine albumin-to-creatinine ratio mediated 79.4%, 33.2% and 31.0%, respectively. Multivariable analyses were not performed due to the very strong mediation effect of hematocrit. In univariable Week 12 landmark change from baseline analyses, the strongest mediators included hematocrit (40.7%), glycated hemoglobin (28.3%), systolic blood pressure (16.8%) and free fatty acids (16.5%), which yielded a combined mediation of 78.9% in multivariable analysis. Conclusions Changes in hematocrit and hemoglobin were the strongest mediators of empagliflozin's kidney benefits in EMPA-REG OUTCOME participants with T2D and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Sleep is essential to adolescent development. Sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) adults are at high risk for poor sleep, partially due to minority stress (e.g., discrimination). However, sleep has rarely been studied among SGM adolescents. In a national sample of early adolescents, we analyzed sexual minority (SM) and gender minority (GM) identity, gender incongruence, and gender nonconformity in association with sleep and tested minority and general stressors as mediators. We cross-sectionally analyzed data from 10,070 adolescents aged 10–14 in the Adolescent Brain Cognitive Development℠ Study. Using logistic regression models, we analyzed associations between identity (SM and GM), sexual identity discrimination, minority and general stressors (sexual identity discrimination, teasing, and conflict with parents) and sleep health (duration, latency, and disturbance). We used Baron and Kenny's method to test for mediation. Participants reported sexual identity (4% SM, 4% questioning) and gender identity (0.4% GM, 0.6% questioning); 65% were White, 20% were Hispanic, and 52% were assigned male at birth. Compared to heterosexual, SM participants had higher odds of short sleep duration, long sleep latency, and sleep disturbance. GM participants and those reporting gender incongruence and nonconformity had higher odds of long sleep latency and sleep disturbance. Sexual identity discrimination and general social stressors partially mediated some associations. SGM participants reported poorer sleep. Minority and general social stressors partially accounted for some disparities. Policies need to address SGM identity-based discrimination and challenge social norms that produce minority stress for SGM early adolescents. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the associations between carbohydrate intake and gout risk, along with interactions between genetic susceptibility and carbohydrates, and the mediating roles of biomarkers. We included 187,387 participants who were free of gout at baseline and completed at least one dietary assessment in the UK Biobank. Cox proportional hazard models were used to estimate the associations between carbohydrate intake and gout risk. Over a median follow-up of 11.69 years, 2548 incident cases of gout were recorded. Total carbohydrate intake was associated with a reduced gout risk (Q4 vs. Q1: HR 0.67, 95% CI 0.60–0.74), as were total sugars (0.89, 0.80–0.99), non-free sugars (0.70, 0.63–0.78), total starch (0.70, 0.63–0.78), refined grain starch (0.85, 0.76–0.95), wholegrain starch (0.73, 0.65–0.82), and fiber (0.72, 0.64–0.80), whereas free sugars (1.15, 1.04–1.28) were associated with an increased risk. Significant additive interactions were found between total carbohydrates and genetic risk, as well as between total starch and genetic risk. Serum urate was identified as a significant mediator in all associations between carbohydrate intake (total, different types, and sources) and gout risk. In conclusion, total carbohydrate and different types and sources of carbohydrate (excluding free sugars) intake were associated with a reduced risk of gout. [ABSTRACT FROM AUTHOR]

The exponential rise of Information and Communication Technology in recent years has brought e-payment systems to the forefront of businesses. Hence, several e-payment options have emerged for consumer and commercial transactions perspective. However, it has led to few challenges for consumer's decision making with respect to the adoption of e-payment system. Therefore, we developed and tested a model of e-payment adoption with respect to consumer empowerment theory. The study also examined the mediating role of consumer empowerment on the relationship between consumer digital awareness (CDA), consumer digital literacy (CDL), consumer digital engagement (CDE) and adoption of e-payment systems. We used a purposive sampling method to collect data from 390 techno savvy respondents from India who used digital payment services. The study found that CDA, CDL and CDE have positive effects on consumer empowerment. This result further partially mediated the relationship between its determinants and adoption intention of the e-payment systems. The findings contributed to the understanding of the dynamics of e-payment system adoption of consumers for developing countries, especially Indian consumers. The empirical results would provide a guideline for decision makers to develop suitable measures that can encourage the adoption of e-payment systems. [ABSTRACT FROM AUTHOR]

Music listening, an inherently emotional activity, is commonly used as a form of emotion regulation (ER). Although research suggests that some strategies of listening to music to regulate emotion are linked with psychological well-being and symptoms of affective disorders, the mechanisms underlying these relationships have not been thoroughly explored. The present study examined whether associations between music as ER and symptoms of depression and anxiety were mediated by individuals' use of other adaptive and maladaptive ER strategies. A nationwide online sample of US adults (n = 146) completed measures assessing their use of music as ER, other adaptive and maladaptive ER strategies, and symptoms of depression and anxiety. The results indicated that the overall use of music as ER was not directly associated with symptoms of depression and anxiety, whereas using music as discharge (venting negative emotions by listening to mood-congruent music) was positively associated with such symptoms. Mediational analyses revealed that adaptive ER mediated the relationship between overall use of music as ER and symptoms of depression and anxiety, whereas maladaptive ER mediated the relationships between discharge and symptoms. These findings suggest that people use music as ER alongside their other ER efforts, which in turn are linked with symptoms of depression and anxiety. Furthermore, although the overall use of music to regulate emotion may be beneficial for well-being via its association with adaptive ER, a more maladaptive pattern when using music for emotional discharge suggests that music plays a more nuanced role in ER and mental health. [ABSTRACT FROM AUTHOR]

Background: The relationship between gut microbiota and vertigo, specifically Benign Paroxysmal Vertigo (BPV) and Vertigo of Central (VC), remains underexplored. Aim and hypotheses: This study aims to investigate the causal relationships between gut microbiota and two types of vertigo, BPV and VC. Additionally, the study seeks to explore the mediation effects of metabolic, inflammatory, and psychological factors on these relationships. We hypothesize that specific taxa of gut microbiota have a causal effect on the risk of developing BPV and VC. The mediation effects of HbA1c, obesity, major depression, and interleukin-18 levels significantly influence the relationships between gut microbiota and vertigo. Method: Utilizing a bidirectional two-sample Mendelian randomization approach, this study investigated causal associations between gut microbiota and the two types of vertigo. A network MR assessed mediation effects of HbA1c, major depression, obesity, and interleukin-18 levels, with data sourced from several consortia, including MiBioGen. Results: Distinct gut microbiota displayed varying influences on BPV and VC risks. A total of ten taxa affect BPV. Among these, two taxa have an odds ratio (OR) greater than 1, including one class, one order. Conversely, eight taxa have an OR less than 1, encompassing four families, three genera, and one order. The OR for these taxa ranges from 0.693 to 0.930, with p-values between 0.006 and 0.048. For VC, eight taxa were found to have an impact. Five of these taxa exhibit an OR greater than 1, including four genera and one phylum. The OR for these taxa ranges from 1.229 to 2.179, with p-values from 0.000 to 0.046. The remaining three taxa have an OR less than 1, comprising one family and two genera, with an OR range of 0.445 to 0.792 and p-values ranging from 0.013 to 0.050. The mediation analysis for BPV shows that major depression, obesity, and HbA1c are key mediators between specific taxa and BPV. Major depression mediates 28.77% of the effect of family Rhodospirillaceae on BPV. Obesity mediates 13.90% of the effect of class Lentisphaeria/order Victivallales. HbA1c mediates 11.79% of the effect of genus Bifidobacterium, 11.36% of family Bifidobacteriaceae/order Bifidobacteriales. For VC, interleukin-18 levels and major depression are significant mediators. Interleukin-18 levels mediate 6.56% of the effect of phylum Actinobacteria. Major depression mediates 6.51% of the effect of genus Alloprevotella. Conclusion: The study highlights potential causal links between gut microbiota and vertigo, emphasizing metabolic and psychological mediators. These insights underscore the therapeutic potential of targeting gut health in vertigo management. [ABSTRACT FROM AUTHOR]

Introduction: Self-employed people without personnel mostly behave like consumers in managing their business finances, frequently leading to ill-management of the company finances. Ill-management may lead to inability to fulfill important financial obligations and making financial arrangements for the future. Here, we investigate the hypothesis that financial management is related to tax compliance. Methods: We use having an overview of expenses, making ends meet, occurrence of a business bank overdraft, and how long the business could survive without income, as indicators of financial management. Four measures of tax compliance, i.e., the OECDmeasure of tax compliance,measures taken by the tax administration, enforced tax compliance, and voluntary tax compliance, and two measures of social security, i.e., pension and disability arrangements, are included. We use survey data from a sample of 1,191 Dutch self-employed people without personnel, roughly equally divided between starters (=3 years in business) and non-starters (>3 years in business). Results: We found both significant direct and indirect effects of mental budgeting on tax compliance and social security arrangements, thus showing incomplete mediation effects of financial management. Discussion: The mediation effects of having an overview of expenses were relatively strong for the OECD and voluntary compliance measures, whereas the mediation effects of not making ends meet and bank overdrafts were relatively strong for measures taken by the tax administration and enforced compliance, thus indicating different financial management processes matching different motivations of tax compliance. [ABSTRACT FROM AUTHOR]

Background: Given the global shifts in environmental conditions and dietary habits, understanding the potential impact of dietary factors and body mass index (BMI) on respiratory diseases, including asthma, is paramount. Investigating these relationships can contribute to the formulation of more effective prevention strategies. The Planetary Health Diet Index (PHDI), a dietary scoring system that balances human health with environmental sustainability, underscores the importance of increasing the consumption of plant-based foods while reducing the intake of red meat, sugar, and highly processed foods. The objective of this study was to assess the association between PHDI and the prevalence of asthma and the mediation effect of BMI in a US general population. Methods: This study utilized data from 32,388 participants in the National Health and Nutrition Examination Survey (NHANES) spanning from 2005 to 2018. Multivariate logistic regression and weighted quantile sum (WQS) regressions were employed to investigate the association between PHDI, individual nutrients, and asthma. Restricted cubic spline (RCS) analysis explored the linear or non-linear relationship between PHDI and asthma. Interaction analyses were conducted on subgroups to validate the findings. Mediation analysis was performed to examine the effect of BMI on the relationship between PHDI and asthma. Results: There was a significant negative association between PHDI and asthma. After adjusting for covariates, for every 10-point increase in PHDI, there was a 4% decrease in the prevalence of asthma (P = 0.025). Moreover, as PHDI increased, there was a trend towards lower asthma prevalence (P for trend < 0.05). WQS analyses showed consistent associations (OR = 0.93, 95%CI: 0.88, 0.98), with Fiber, Vitamin C, and Protein significant factors. The dose-response curve indicated a linear association between PHDI and asthma, with higher PHDI associated with lower asthma prevalence. Additionally, BMI is significantly positively associated with asthma (P < 0.001), and BMI decreases as the PHDI increases (β = -0.64, P < 0.001). Mediation analysis indicates that BMI significantly mediates the relationship between PHDI and asthma, with a mediation proportion of 33.85% (P < 0.001). Conclusion: The results of this study show a strong negative correlation between PHDI and the prevalence of asthma. In addition, BMI mediated this negative relationship. [ABSTRACT FROM AUTHOR]

Timely degree completion is a topic of interest for numerous stakeholders, including university officials, students, and parents. Unfortunately, a significant number of students encounter challenges within university settings that postpone degree completion or contribute to academic dropout. The available literature suggests that emotional intelligence functions as a protective factor that promotes academic resilience and decreases the likelihood of academic dropout. However, the mechanisms by which emotional intelligence supports degree completion are not fully understood. Therefore, the current study was designed to investigate if the relationship between emotional intelligence and dropout intentions is mediated by task-value and expectancy. University students (N = 337; 66.97% Caucasian/White; 85.89% female; Mean Age = 27.92) completed the Wong and Law Emotional Intelligence scale, self-report measures of task-value (i.e., attainment, intrinsic, utility, & cost) and expectancy, and the Dropout Intentions scale. Using mediation analysis, we determined there was no direct relationship between emotional intelligence and dropout intention. However, indirect effects revealed the relationship between emotional intelligence and dropout intention is mediated by intrinsic and attainment value. These results offer insights into how emotional intelligence may contribute to academic retention and have implications for interventions and support services designed to promote on-time degree completion. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown that adverse childhood experiences (ACEs) lead to adverse social relations in middle-aged and older adults and harm physical and mental health, but few studies have focused on the impact of ACEs on marital status in middle-aged and older adults and the potential influence of marital status between ACEs and depressive symptoms. Purpose: This study aimed to analyze the effect of ACEs on marital status and depressive symptoms in the Chinese middle-aged and older adults, and to explore the mediating role of marital status in the association between ACEs and depressive symptoms in middle-aged and older adults. Method: This study used the China Health and Retirement Longitudinal Study (CHARLS) 2014 life history survey and 2015 and 2018 follow-up data to analyze, ten ACEs conditions and marital status were collected by questionnaire, using the Center for Epidemiological Studies Depression Scale (CESD-10) 10-item short form to assess depressive symptoms. The association between cumulative ACEs and marital status was assessed by constructing a multinomial logistic regression (MLR) model, as well as a binary logistic regression model to assess the association between ACEs and depressive symptoms. The mediating role of marital status in the association between ACEs and depressive symptoms was also assessed. Results: A total of 10,246 individuals aged 45 years or older were included in the analysis. Compared to individuals who did not experience ACEs, those who experienced two or more ACEs had a higher risk of being unmarried (seperated/divorced/never married) (OR = 1.67, 95% CI=[1.10,2.51]) and a higher risk of depressive symptoms (OR = 1.66, 95% CI=[1.49,1.84]) in middle and old age. Unmarried status partially mediated the association of ACEs with depressive symptoms. Conclusion: Chinese middle-aged and older people who experienced two or more ACEs have higher risks of unmarried status and depressive symptoms, and unmarried status partially mediated the ACEs-depressive symptom association. These findings reveal the fact that we need to develop life-cycle public health strategies to reduce exposure to ACEs and society should give more attention to the marital status of older people, thereby reducing the risk of depression among middle-aged and older adults in China. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia and abnormal cholesterol metabolism are closely related to coronary artery calcification (CAC) and are also critical factors in cardiovascular disease death. In recent years, the atherogenic index of plasma (AIP) has been widely used to evaluate vascular sclerosis. This study aimed to investigate the potential association of AIP between CAC and major adverse cardiovascular events (MACEs). Methods: This study included 1,121 participants whose CACs were measured by multislice spiral CT. Participants' CAC Agatston score, CAC mass, CAC volume, and number of vessels with CACs were assessed. AIP is defined as the base 10 logarithm of the ratio of triglyceride (TG) concentration to high-density lipoprotein-cholesterol (HDL-C) concentration. We investigated the multivariate-adjusted associations between AIP, CAC, and MACEs. The mediating role of the AIP in CAC and MACEs was subsequently discussed. Results: During a median follow-up of 31 months, 74 MACEs were identified. For each additional unit of log-converted CAC, the MACE risk increased by 48% (HR 1.48 [95% CI 1.32–1.65]). For each additional unit of the AIP (multiplied by 10), the MACEs risk increased by 19%. Causal mediation analysis revealed that the AIP played a partial mediating role between CAC (CAC Agatston score, CAC mass) and MACEs, and the mediating proportions were 8.16% and 16.5%, respectively. However, the mediating effect of CAC volume tended to be nonsignificant (P = 0.137). Conclusions: An increased AIP can be a risk factor for CAC and MACEs. Biomarkers based on lipid ratios are a readily available and low-cost strategy for identifying MACEs and mediating the association between CAC and MACEs. These findings provide a new perspective on CAC treatment, early diagnosis, and prevention of MACEs. [ABSTRACT FROM AUTHOR]

Background: This study aims to assess the causal relationship between immune cell characteristics and malignant tumors of bone and articular cartilage, focusing on the mediating role of metabolites. Using Mendelian randomization, we evaluated these relationships based on genetic variations to identify potential biomarkers and therapeutic targets. Methods: A two-sample Mendelian randomization analysis was conducted using GWAS data for immune cell features and 1,400 metabolites to investigate direct and mediating effects. Effective instrumental variables (IVs) were selected, and statistical analyses--including inverse variance weighting (IVW), weighted median, and mode-based methods--were performed using R software. This approach enabled the assessment of direct causal relationships as well as the potential mediating role of metabolites in the association between immune cell features and malignancies. Results: Significant causal relationships were identified between 26 immune phenotypes and the risk of malignant tumors of bone and articular cartilage. Notably, the HLA DR+ NK cell phenotype SSC-A showed a positive correlation with the risk of these malignancies. Further analysis revealed causal relationships with 67 metabolites, 38 of which were positively correlated and 29 negatively correlated. Mediation analysis highlighted the role of immune surveillance and metabolic dysregulation in tumor development, as evidenced by the association between the immune phenotype SSC-A on HLA DR+ NK cells and the metabolite 5-hydroxyhexanoate. Conclusion: The findings suggest significant causal relationships between immune phenotypes and malignant tumors of bone and articular cartilage, with metabolites potentially mediating these relationships. These insights lay the groundwork for further research and could contribute to the development of new biomarkers and treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Within the NICU, there is a delicate equilibrium between providing assistance to parents by nurses and prioritising family-centred care (FCC). The FCC assumes the role of a mediator, effectively conveying compassion. The intricate dynamics between FCC, parental nurse support, and parental stress in neonatal intensive care units (NICUs) necessitate comprehensive investigation. Objective: This study examines the mediating effect of FCC on the relationship between parental nurse support and parental stress in NICUs. Methods: This cross-sectional observational study used convenience sampling to select 223 parents (202 mothers) from Mansoura City hospitals in Egypt. Data were collected using the Nurse Parent Support Tool (NPST), Family-Centered Care Self-Assessment Tool (FCCS-NICU), and the Parental Stressor Scale: NICU (PSS: NICU). Mediation analysis was used to examine the relationships between variables. Results: Nurse support was positively associated with FCC (β = 0.81, p < 0.001) and negatively related to parental stress (β=-1.156, p < 0.001). FCC was found to reduce parental stress (β=-0.18, p < 0.001). Mediation analysis confirmed that FCC partially mediated the relationship between nurse support and parental stress (indirect effect β = 0.145, 95% CI: 0.055–1.007). Conclusions: This study highlights a significant association in the mediating role of FCC between nurse support and parental stress. Strengthening FCC practices can be an effective strategy for nurses to support parents and alleviate their stress in NICU settings. Implications to practice: NICUs should implement FCC-oriented training for nurses, foster a culture that supports FCC principles, and develop policies to establish FCC as a cornerstone of neonatal care. [ABSTRACT FROM AUTHOR]

Well-being is a continuous process requiring decisions and actions to maintain or build health. This study examines the indirect effect of health locus of control on life satisfaction via healthy behaviors based on living systems theory. Participants were 730 students of various majors related to medicine and health, aged between 19 and 30 (M = 22.29, SD = 1.64), including 79.04% women. Self-report measures were used to assess life satisfaction, multidimensional health locus of control, and health behavior. Women scored higher than men on the total health behavior scale, especially in a healthy diet and preventive behavior. Men scored higher than women on internal health locus of control (HLC), while women scored higher than men on the powerful others HLC in making decisions about their health. The study confirmed the mediating effect of healthy behavior on the relationship between the internal HLC and life satisfaction. The present mechanism highlights the crucial role of internal motivation in increasing subjective well-being by maintaining health behaviors among young adults. The role of intervention programs focused on improving internal HLC and health behaviors is discussed. [ABSTRACT FROM AUTHOR]

Aims and Objective: To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care. Background: Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence. Design: Descriptive and correlational design. Methods: The study was conducted among newly graduated nurses (n = 201) working in acute care hospitals for 1–12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist. Results: The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care. Conclusions: Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses. Relevance to Clinical Practice: The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education. [ABSTRACT FROM AUTHOR]

This study aimed to understand how psychological factors affect regular exercise in older adults, hypothesising that trait self-control mediates the relationship between motivation types (intrinsic, extrinsic, and amotivation) and exercise time. In this cross-sectional study, 430 older adults (mean age = 68.8 ± 6.72) completed questionnaires regarding their perceived trait self-control, motivation towards leisure activities, and level of physical activity. A Bayesian mediation analysis was performed, controlling for demographics. We documented positive direct (c′ = 0.021, 95%CI [0.001, 0.043]) and indirect (ab = 0.028, 95%CI [0.014, 0.043]) effects of intrinsic motivation on exercise, a fully mediated indirect effect of extrinsic motivation on exercise (ab = 0.027, 95%CI [0.011, 0.046]), and negative direct (c′ = −0.281, 95%CI [−0.368, −0.194]) and indirect (ab = −0.161, 95%CI [−0.221, −0.105]) effects of amotivation on exercise. There was no direct association between extrinsic motivation and exercise (c′ = 0.013, 95% CI [−0.013, 0.037]). In conclusion, trait self-control mediates motivation to influence exercise behaviour in older adults. Intrinsically motivated individuals resist sedentary living and show higher self-control, while extrinsically motivated ones rely on self-control and are more susceptible to non-adherence during mental fatigue. High amotivation is linked to less exercise and reduced self-control, suggesting potential non-compliance with structured exercise interventions. [ABSTRACT FROM AUTHOR]

This study analyzes whether the personality traits of Members of Parliament (MPs) affect their attitudes toward the representation of gender equality issues. Based on the Big Five personality traits, we argue that Openness to Experience and Conscientiousness shape MPs' positions toward gender equality policies through two different pathways. The first pathway proposes a direct connection. While Openness is expected to positively affect MPs' support for gender equality, Conscientiousness is assumed to have a negative impact. The second pathway runs indirectly, linking Openness and Conscientiousness to preferences toward gender equality through the effect of these personality traits on MPs' general ideological positions. Using data from a survey of elite politicians in Germany and Switzerland, the results of a causal mediation analysis show a positive direct effect of Openness that holds independent of a mediating influence of political ideology. The analysis deepens our understanding of gender equality legislation and the MPs engaging in it. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that physical activity (PA) and leisure sedentary behaviors (LSB, including leisure television watching) are linked to gastroesophageal reflux disease (GERD). However, the associations between PA/LSB and GERD remain controversial. In this study, we aimed to reveal whether these associations reflect causal relationships and reveal the potential mechanisms of these relationships using bidirectional and two-step Mendelian randomization (MR) analyses. Methods: We obtained genome-wide association study (GWAS) summary statistics for PA/LSB, four common risk factors (including cigarettes smoked per day, alcoholic drinks per week, triglycerides, total cholesterol) and GERD from published GWASs. A bidirectional MR analysis was performed to identify causal relationships between PA/LSB and GERD. Then, a series of sensitivity analyses were performed to verify the robustness of the results. Finally, a mediation analysis via two-step MR was conducted to investigate any effects explained by common risk factors in these relationships. Results: Genetically predicted per 1-SD increase in leisure time television watching significantly increased the risk of GERD in the bidirectional MR analysis (OR = 1.33; 95% CI: 1.14–1.56; P = 2.71 × 10− 4). Sensitivity analyses successfully verified the robustness of the causal relationship. Further mediation analysis showed that this effect was partly mediated by increasing cigarettes smoked per day, with mediated proportions of 18.37% (95% CI: 11.94-39.79%). Conclusion: Our findings revealed a causal relationship between leisure television watching and an increased risk of GERD, notably, the causal effect was partially mediated by cigarettes smoked per day. These findings may inform prevention and management strategies directed toward GERD. [ABSTRACT FROM AUTHOR]

Background: Remnant cholesterol (RC) reportedly contributes to the development of diabetes mellitus. However, evidence on the relationship between maternal RC and the risk of developing gestational diabetes mellitus (GDM) during pregnancy is limited. This study aimed to assess the relationship between maternal RC and GDM risk during early pregnancy, and explore the potential pathways involved in the relationship between RC levels and GDM risk. Methods: From 2018 to 2021, a prospective birth cohort study was designed and carried out in China. The associations of maternal RC and other lipid parameters with GDM risk were estimated using logistic regression models and restricted cubic splines. Subgroup analyses were performed stratified by prepregnancy body mass index (pre-BMI), maternal age and gravidity. Mediation analyses were conducted to explore the mediating effect of some related factors on the relationship between RC levels and the risk of GDM. Results: A total of 33,018 pregnant women were included. The median RC level was 0.47 ± 0.20 mmol/L. The prevalence of GDM was 15.19%. As RC quartiles increased, the incidence of GDM increased substantially, reaching 19.24% for the highest quartile of RC (P < 0.001). Maternal RC in the first trimester was positively correlated with GDM risk (OR: 2.254, 95% CI: 1.943–2.615). Compared to the lowest RC quartile, higher RC quartiles were correlated with an increased risk of GDM, and the ORs (95% CIs) for Q3 and Q4 were 1.208 (1.101–1.325) and 1.489 (1.364–1.626), respectively. Moreover, a linear dose–response relationship was found for this association (P for all < 0.001, P for nonlinearity > 0.05) and was consistent across subgroups with different pre-BMIs, maternal ages and gravidities (all P values for interactions > 0.05). Furthermore, the correlation between RC level and GDM risk was partially mediated by pre-BMI (9.20%) and blood glucose level (-11.1%). Conclusions: Higher maternal RC levels in the early stage of pregnancy was positively associated with an increased risk of developing GDM. This association was partially mediated by pre- BMI and blood glucose levels. [ABSTRACT FROM AUTHOR]