The mediating effects of digital literacy and self-efficacy on the relationship between learning attitudes and Ehealth literacy in nursing students: A cross-sectional study

BACKGROUND

eHealth literacy (eHL) is considered an important competency among healthcare providers in healthcare systems, especially following the introduction of information and communication technologies.

OBJECTIVES

This study aimed to identify the relationship and direction of factors affecting nursing students' eHL in an online learning environment.

DESIGN

A cross-sectional study.

SETTINGS

Three nursing colleges located in Gyeonggi-do and Gangwon-do in Korea.

PARTICIPANTS

Participants were 259 nursing students aged 18-29 years who lived in the Seoul metropolitan area.

METHODS

Self-reported data on variables including attitudes toward online learning, digital literacy, self-efficacy, and eHL, were collected and analyzed using an independent t-test and one-way analysis of variance. The mediating effects were verified through the bootstrapping method using the PROCESS macro for SPSS.

RESULTS

The results indicated that although attitudes toward online learning affected digital literacy, they did not directly influence eHL. Additionally, digital literacy and self-efficacy were also found to be associated with eHL and mediate the relationship between online learning attitudes and eHL.

CONCLUSIONS

As online nursing education rapidly becomes commonplace due to the COVID-19 pandemic, attitudes toward online learning, digital literacy, and self-efficacy must be improved to enhance eHL.

The impact and mechanisms of the Shanghai pilot free-trade zone on the green total factor productivity of the Yangtze River Delta Urban Agglomeration

Free-trade zones are highlands of regional development that have a radiating effect on surrounding cities. This paper uses Yangtze River Delta Urban Agglomeration (YRDUA) data from 2003 to 2018, to examine the impact of the China (Shanghai) pilot free-trade zone (SPFTZ) on green total factor productivity (GTFP) in the YRDUA. It uses the regression discontinuity (RD) method and analyzes the influence mechanism with the help of the mediating effect model. The paper presents the following major findings. The establishment of the SPFTZ significantly promoted GTFP in the YRDUA, with technological progress being the main driving force. An analysis using the mediating effect model found that financial efficiency and industrial structure upgrading play a complete mediating role in GTFP growth in the YRDUA. Therefore, the SPFTZ should make use of its policy advantages, take full advantage of the effect of the green growth pole, and promote green mutual development with the YRDUA.

How natural disasters affect carbon emissions: the global case

The outbreak of the COVID-19 pandemic has once again made the impacts of natural disasters a hot topic in academia. The environmental impacts of natural disasters, however, remain unsettled in the existing literature. This study aims to investigate the impact of natural disasters on CO₂ emissions. For this purpose, we employ a panel dataset covering 138 countries over the period 1990-2018 and two dynamic panel estimation methods. Then, considering the differences in CO₂ emissions across various countries, we run a panel quantile regression to examine the asymmetry in the nexus between natural disasters and CO₂ emissions. We also discuss the mediating effects of energy consumption between natural disasters and CO₂ emissions. After conducting a series of robustness checks, we confirm that our results are stable and convincing. The empirical results indicate that natural disasters significantly reduce CO₂ emissions. Nevertheless, the impact of natural disasters on CO₂ emissions is asymmetric across different quantiles of CO₂ emissions. Furthermore, the technology level serves as an important moderating factor between natural disasters and CO₂ emissions. The mediating effect results reveal that natural disasters not only directly reduce CO₂ emissions but also indirectly promote carbon reduction by restraining energy consumption. Finally, several policy implications are provided to reduce CO₂ emissions and the damage caused by natural disasters.

How does green technology innovation affect urbanization? An empirical study from provinces of China

The construction of new-type urbanization with the theme of innovation, green, and smart development is becoming the endogenous driving force of China's economic transformation and upgrading, and green technological innovation is a key factor in cracking the problems of development motivation and environmental constraints in urbanization construction. This paper investigates the impact of green technology innovation on urbanization based on a panel dataset covering 30 provinces in China from 2005 to 2019. First, we use the entropy method and the super-efficiency DEA method to measure the level of urbanization and green technology innovation, respectively. Moreover, on this basis, we use panel regression model and FGLS model to estimate the direct impact of green technological innovation on urbanization and its three dimensions-population urbanization, industrial urbanization, and ecological urbanization. Then, the mediating effect model is used to further study the indirect impact of green technological innovation on urbanization. The results indicate that green technological innovation is the most effective way to promote the development of new urbanization currently. In addition, green technology innovation can indirectly affect urbanization through the effects of foreign capital, energy consumption and information development, while the effect of industrial structure optimization effects is not significant. Finally, some policy suggestions are discussed to better promote the development of urbanization in China.

Impact of green credit on green economy efficiency in China

With urgent desire of promoting sustainable development, this study explored the impact and affecting mechanism of green credit on green economy efficiency through spatial lag model. Panel data from 2008 to 2019 of 30 selected provinces and cities in China were collected to portray the green economy efficiency with application of Sup-SBM DEA including unexpected outputs. The results show that (1) green credit had significant promoting effect on green economy efficiency, while time-space inconsistency existed. (2) During the promoting process, level of marketization and environmental regulation generated threshold effects, which were positively correlated with regional green economy efficiency. (3) Industrial structure upgrading and environmental investment played positive intermediary roles between green credit and green economy efficiency. (4) Considering endogenous issues, the positive effect still existed though the promotion effect was weakened. This study further enriches the literature and provides deep insights into the policy design when formulating the green economy path.

Technology imports, independent innovation, and China's green economic efficiency: an analysis based on spatial and mediating effect

Environmental quality and economic growth are important factors that need to be balanced for sustainable development, especially in developing countries where technology is relatively backward. Many studies have shown that technology imports may be beneficial to economic growth, but once the resources and environment are taken into consideration, the role of technology imports becomes blurred. Based on provincial panel data of China from 2004 to 2019, this paper investigates the influence mechanism of domestic and foreign technology imports on the green economic efficiency (GEE) of 30 provinces in China. There are two main conclusions: First, GEE is spatially related and the impact of technology imports on GEE has a significant spillover effect. Besides, the relationship between technology imports and GEE is non-linear, both in terms of direct and indirect effects. Second, independent innovation plays an important role in the influence mechanism of technology imports on GEE. As the level of independent innovation increased, the impact of technology imports on GEE turns from negative to positive, and it is strengthened through the channel of "transfer-absorption-diffusion-re-innovation." In this regard, some measures should be taken to enhance the role of technology imports in improving GEE.

Prenatal neonicotinoid insecticides Exposure, oxidative Stress, and birth outcomes

BACKGROUND

An increasing number of studies have reported neonicotinoid insecticides (NEOs), the emerging alternatives to conventional insecticides, may increase oxidative stress and cause adverse health effects, but limited is known about the prenatal NEOs exposures and their impact on birth outcomes.

OBJECTIVES

We investigated the levels of prenatal exposure to NEOs/metabolites, to assess their associations with birth outcomes, and investigate whether these associations could be mediated by oxidative stress using 8-OHdG as the biomarker.

METHODS

We studied 296 mother-infant pairs recruited from Laizhou Wan Birth Cohort in 2010 - 2013. Two NEOs (IMI and ACE), three metabolites (6-CN, ND-ACE, and 2CTCA), and 8-OHdG were measured in maternal urine collected before delivery. Birth outcomes including birth weight, birth length, ponderal index (PI), head circumference, and gestational age, were acquired. We examined the associations between NEOs/metabolites and birth outcomes using multivariable linear regression. Mediation analysis was conducted to clarify the role of 8-OHdG on the association of NEOs/metabolites exposure and birth outcomes.

RESULTS

Highest detection rate was observed for ACE (100.0%), followed by IMI (98.3%) and 6-CN (98.0%), suggesting the common exposure of pregnant women. The highest median concentration was observed for 6-CN with creatinine-adjusted median levels of 9.58 μg/g creatinine. A decrease in newborns' head circumference was observed with a 10-fold increase in IMI (β = -1.83; 95% CI = -3.04, -0.62) and ACE (β = -2.27; 95% CI = -3.56, -0.98). An increase in newborns' PI was observed with a 10-fold increase in IMI (β = 0.40; 95% CI = 0.03, 0.75). Maternal 8-OHdG demonstrated 38.5-65.5% mediating effects in the negative association of IMI, ACE, 2-CTCA with head circumference. These associations might differ between boys and girls.

CONCLUSIONS

Pregnant women were widely exposed to NEOs/metabolites in China. Results suggested the potential impacts of prenatal exposure to certain neonicotinoid insecticides on head circumference. Urinary 8-OHdG may partly mediate these associations.

Optimism and survival: health behaviors as a mediator-a ten-year follow-up study of Chinese elderly people

Background

Optimism—the generalized expectation that good things will happen—is a promising health asset. Mounting evidence indicates that there are specific associations between optimism and survival rates. However, for public health purposes, it is critical to consider whether the relationship between optimism and survival holds for older adults as a whole and to explore the role of health behaviors as potential mediators.

Methods

Prospective data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Optimism was measured in 2008, and survival was measured by survival time of the interviewees during the whole observation period from 2008 to 2018. Cox proportional hazard models were employed to evaluate the association between optimism and survival among the elderly. The mediating effect analysis method was used to explore the potential mediating role of health behaviors on the association between optimism and survival.

Results

Compared to less optimistic older adults, optimistic individuals were associated with lower odds of mortality (HR = 0.94, 95% CI = 0.89 − 0.99). Health behaviors are key elements that play a positive role in survival (HR = 0.95, 95% CI = 0.94 − 0.96). Health behaviors played an intermediary role in the relationship between optimism and mortality, and the mediating effect was -0.005.

Conclusions

Optimism and health behaviors were broadly and robustly associated with a lower risk of mortality. Health behaviors mediate the relationship between optimism and mortality. Appropriate intervention should be carried out on optimism and health behaviors among elderly people to improve the likelihood of health in aging.

Relation between diabetes related distress and glycemic control: The mediating effect of adherence to treatment

AIMS

Diabetes related distress (DRD) is a negative emotional reaction to stresses associated with diabetes mellitus (DM) and its management. This study estimated the burden of DRD and self-reported adherence to treatment (SRAT) among patients with DM and investigated their relationship with glycemic control.

METHODS

A cross sectional study of consented 157 diabetics was conducted using the17-item Diabetes Distress Scale (DDS). It measures distress at four subscales: Emotional Burden (EB), Physician-related (PD), Regimen-related (RD) and Interpersonal Distress (ID). SRAT was assessed using Morisky's scale. Glycemic control was assessed using the most recent HbA1c results. Multivariable linear regression analysis was used for adjustment of confounders and bootstrap Confidence Interval was used to test for the occurrence of mediating effect.

RESULTS

Average age was 44.5 ± 16.0 years, 65% were females, 79% had type 2 DM and nearly 55% has had DM for more than 7 years and the average HbA1c was 8.9 ± 2.2%. Clinically significant DRD was reported by 37% of the participants, EB and RD in 40.8%, PD in 46.5%, and ID among 32.5%. Younger patients showed higher level of stress compared to older participants and patients with type 1 DM showed higher level of stress in all DRD domains. Only 46% of patients were defined as having satisfactory SRAT and improvement of SRAT significantly enhanced the glycemic control (r = -0.32, p < 0.01). DRD and low SRAT negatively correlated with HbA1c; increasing the DRD by one point may increase the HbA1c on average by 0.41 (C.I. 0.02-0.80) and will indirectly raise the HbA1c by 0.24 (C.I. 0.04-0.47) through the mediating effect of low SRAT.

CONCLUSION

DRD and low SRAT are commonly reported among DM patients and both are indirectly correlated. The mediating effect of low SRAT highlights the clinical role of DRD and clarifies the process by which distress affect the outcome of DM management.

Association between systemic inflammation and activities of daily living disability among Chinese elderly individuals: the mediating role of handgrip strength

BACKGROUND

Aging is accompanied by chronic low-grade inflammation (inflammaging), which is a risk factor for low handgrip strength (HGS) and activities of daily living (ADL) disability.

AIMS

To explore the association between C-reactive protein (CRP) and ADL disability in Chinese elderly individuals and to further evaluate the mediating role of HGS in this association.

METHODS

We used data from the China Health and Retirement Longitudinal Study (CHARLS) that were collected in 2015. A total of 3601 elderly individuals aged ≥ 60 years were included. Baron and Kenny's causal steps method was used to explore the possible mediating role of HGS in the associations between CRP and ADL disability. Karlson-Holm-Breen method was further applied to decompose total effect into direct effect and indirect effect via HGS. Subgroup analysis was conducted by sex and age.

RESULTS

A high level of CRP (≥ 3 mg/L) was significantly associated with ADL disability after adjustment for covariates (OR = 1.50, 95% CI = 1.17-1.94). After introducing HGS into the model, the risk estimate was reduced but still significant (OR = 1.40, 95% CI = 1.08-1.81). The proportional mediation through HGS was 14.71%. Similar results were observed in both sexes and in participants aged < 70 years.

CONCLUSION

CRP was positively associated with the risk of ADL disability in Chinese elderly individuals, and this association was mediated by HGS. Improving muscle strength in combination with anti-inflammatory treatment may have a beneficial effect to maintain ADL ability. Further randomized controlled trials on this topic are necessary.

How does working memory matter in young children's arithmetic skills: The mediating role of basic number processing

The current study investigated whether and how each component of the working memory model was associated with kindergarten children's arithmetic performance. A total of 103 Chinese kindergarten children were administered tests of the visuospatial sketchpad, the phonological loop, the central executive, and basic number processing (i.e., number line estimation, nonverbal numerosity estimation and numerical magnitude comparison). The results showed that among the three working memory components, the central executive accounted for a significant proportion of the variance in young children's arithmetic performance. In terms of basic number processing, number line estimation and numerical magnitude comparison had significant influences on young children's arithmetic performance. Furthermore, numerical magnitude comparison played a mediating role between the visuospatial sketchpad and early arithmetic skills. These findings highlight the importance of working memory and basic number processing in early arithmetic skills and reveal different pathways through which the three working memory components influence young children's arithmetic performance.

Coenzyme Q10 supplementation improves adipokine profile in dyslipidemic individuals: a randomized controlled trial

Background

In previous study, we found that coenzyme Q10 (CoQ10) improved glucolipid profile in dyslipidemic individuals, but the mechanism is not yet clear. Adipokines have been demonstrated to be vital targets of metabolic diseases. The hypothesis that adipokines mediate the association of CoQ10 on glucolipid metabolism needs to be further studied in human.

Methods

In this randomized, double-blinded, placebo-controlled trial, 101 dyslipidemic individuals were administrated to 120 mg CoQ10 or placebo for 24 weeks. Anthropometric parameters, glucolipid profile, serum total adiponectin, leptin, and resistin were evaluated at baseline, week 12 and week 24.

Results

CoQ10 treatment significantly increased serum adiponectin levels at week 12 (165 [0, 362] ng/mL, p < 0.001) and at week 24 (523 [0, 1056] ng/mL, p < 0.001]), which was significant different compared with placebo (p < 0.001). The increase of adiponectin was negative associated with decrease in index of homeostasis model assessment of insulin resistance (HOMA-IR, r = − 0.465, p = 0.001), triglyceride (TG, r = − 0.297, p = 0.047), and low-density lipoprotein cholesterol (LDL-c, r = − 0.440, p = 0.002) at week 24 only in CoQ10-treated group. Resistin was reduced by CoQ10 only at week 24 (− 1.19 [− 4.35, 0.00] ng/mL, p < 0.001), which was significant different compared with placebo (p < 0.001). Reduction of resistin was positively correlated with the change in HOMA-IR (r = 0.343, p = 0.021) and TG (r = 0.323, p = 0.030) at week 24 in CoQ10-treated group but not placebo group. Leptin was not influenced by CoQ10 treatment. Mediation analysis indicated that the improvement of HOMA-IR, TG and LDL-c by CoQ10 was mediated by adiponectin but not resistin.

Conclusions

Our study shows that CoQ10 ameliorates glucolipid profile and adipokines dysfunction in dyslipidemic patients in 24 weeks’ intervention. The beneficial effect of CoQ10 on glucolipid profile was mediated by adiponectin. Trial registration: ClinicalTrials.gov, NCT02407548. Registered on April 3, 2015, https://clinicaltrials.gov/ct2/show/NCT02407548.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12986-022-00649-5.

Nurses' turnover intention, hope and career identity: the mediating role of job satisfaction

Background

A high turnover rate has become a critical issue in the field of nursing and how to tackle the problem of nursing turnover has received increased attention worldwide. Hope, career identity, job satisfaction may be useful for reducing turnover. The aim of this study is to explore the relationships among career identity, hope, job satisfaction, and the turnover intention of nurses, and to test the mediating role of job satisfaction on the associations of hope and career identity with turnover intention.

Methods

A descriptive cross-sectional design was used. A total of 500 nurses were recruited from five comprehensive tertiary hospitals using convenience sampling. The questionnaire included items about sociodemographic information as well as the Adult Dispositional Hope Scale, Nursing Career Identity Scale, Job Satisfaction Index Scale, and Nurse Turnover Intention Scale. Pearson’s correlation, multiple linear regression, and structural equation modeling were used to analyze the data. We describe the study in accordance with the STROBE statement.

Results

Hope (r = − 0.227, p < 0.001) and career identity (r = − 0.342, p < 0.001) were negatively correlated with turnover intention. Job satisfaction played a completely mediating role on the associations of hope and career identity with turnover intention (β₁ = − 0.09, β₂ = − 0.33).

Conclusions

Job satisfaction mediated the associations of career identity and hope with turnover intention. Thus, effective measures can be taken to enhance nurses’ hope and career identity in order to improve their job satisfaction and thereby reduce their turnover intention. Providing nurses with more support, helping them find a spiritual foundation, and holding mindful activities that stimulate positive emotions are helpful. In addition, colleges should pay more attention to instilling nursing students with career identity and nursing values.

The impact of corporate characteristics and external pressure on environmental information disclosure: a model using environmental management as a mediator

Since the beginning of the 21st century, a number of regulations on corporate environmental information disclosure have been issued. Given the bottom-up nature of environmental information disclosure policy, increasing concerns about influencing factors have emerged; however, the specific influencing factors and mechanisms of environmental information disclosure remain unknown. This article explores the influencing factors and mechanisms of corporate environmental information disclosure. Through a random-effect GLS regression analysis of 363 listed manufacturing companies from the Shanghai Stock Exchange for 2012-2018, we find empirical support for our prediction that the link between internal/external factors and environmental information disclosure is mediated by corporate environmental management. Some characteristics of environmental information disclosure are also identified. We present influencing mechanisms from a corporate perspective, which will be useful for top managers and regulators interested in enhancing environmental information disclosure.

The treatment effect of the Shanxi Comprehensive Reform Area policy on PM2.5 concentrations: A study based on a quasi-experiment

Based on panel data on 248 prefecture-level cities in China from 2003 to 2018, this study first estimates the treatment effect of the Shanxi Comprehensive Reform Area policy on PM_2.5 concentrations using a PSM-DID method within the counterfactual framework. The average treatment effect shows that contrary to the naive before-after analysis, on average, the Shanxi Comprehensive Reform Area policy significantly increased the PM_2.5 concentrations of prefecture-level cities in Shanxi Province by 0.211% annually, and the place-based placebo test shows that the treatment effect obtained above is robust. Second, the dynamic treatment effects show a continuous decrease in incremental effects during 2011-2018, gradually decreasing from a significant positive increment during 2011-2015 to a zero or even a negative increment during 2016-2018, indicating that the Shanxi Comprehensive Reform Area policy gradually increased in environmental friendliness. Third, the mediating effects estimated by the causal steps procedure show that the Shanxi Comprehensive Reform Area policy influenced PM_2.5 concentrations by increasing the intensity of resource exploitation and decreasing the intensity of environmental regulations, but the capacity of scientific and technological innovations had no mediating effect on the relationship between the policy and PM_2.5 concentrations. Therefore, the government should further reduce the intensity of resource exploitation, strengthen the intensity of environmental regulations, and promote environmentally focused scientific and technological innovations to reduce PM_2.5 concentrations in Shanxi Province.

Online risky behavior and sleep quality among Chinese college students: The chain mediating role of rumination and anxiety

This study explored the chain mediating effects of rumination and anxiety in the relationship between online risky behavior and sleep quality among Chinese college students. A sample of 1039 Chinese college students (Mage = 19.49, SD = 1.14, 53.32% males) were investigated with Online Risky Behavior Scale (ORBS), Pittsburgh Sleep Quality Index scale (PSQI), Ruminative Responses Scale (RRS) and Self-rating Anxiety Scale (SAS). The results showed that: (1) There is a significant positive correlation among online risky behavior, sleep quality, rumination and anxiety, and (2) Online risky behavior could not directly affect sleep quality, but it can affect sleep quality through the mediation of rumination and anxiety. The chain mediating effects includes three paths: The mediating role of rumination, the mediating role of anxiety, and the chain mediating role of rumination and anxiety after controlling for gender, grade, major, and network usage time. These findings contribute to a deeper understanding of how online risky behavior affects sleep quality and provide important practical guidance for improving sleep quality.

Association between HLA alleles and sub-phenotype of childhood steroid-sensitive nephrotic syndrome

BACKGROUND

Few studies have addressed the effects of human leukocyte antigen (HLA) alleles on different clinical sub-phenotypes in childhood steroid-sensitive nephrotic syndrome (SSNS), including SSNS without recurrence (SSNSWR) and steroid-dependent nephrotic syndrome/frequently relapse nephrotic syndrome (SDNS/FRNS). In this study, we investigated the relationship between HLA system and children with SSNSWR and SDNS/FRNS and clarified the value of HLA allele detection for precise typing of childhood SSNS.

METHODS

A total of 241 Chinese Han individuals with SSNS were genotyped using GenCap-WES Capture Kit, and four-digit resolution HLA alleles were imputed from available Genome Wide Association data. The distribution and carrying frequency of HLA alleles in SSNSWR and SDNS/FRNS were investigated. Additionally, logistic regression and mediating effects were used to examine the relationship between risk factors for disease process and HLA system.

RESULTS

Compared with SSNSWR, significantly decreased serum levels of complement 3 (C3) and complement 4 (C4) at onset were detected in SDNS/FRNS (C3, P < 0.001; C4, P = 0.018). The average time to remission after sufficient initial steroid treatment in SDNS/FRNS was significantly longer than that in SSNSWR (P = 0.0001). Low level of C4 was further identified as an independent risk factor for SDNS/FRNS (P = 0.008, odds ratio = 0.174, 95% confidence interval 0.048-0.630). The HLA-A*11:01 allele was independently associated with SSNSWR and SDNS/FRNS (P = 0.0012 and P = 0.0006, respectively). No significant HLA alleles were detected between SSNSWR and SDNS/FRNS. In addition, a mediating effect among HLA-I alleles (HLA-B*15:11, HLA-B*44:03 and HLA-C*07:06), C4 level and SDNS/FRNS was identified.

CONCLUSIONS

HLA-I alleles provide novel genetic markers for SSNSWR and SDNS/FRNS. HLA-I antigens may be involved in steroid dependent or frequent relapse in children with SSNS as mediators of immunoregulation.

Quality of work life and work engagement among nurses with standardised training: The mediating role of burnout and career identity

AIM

To explore the impact of the quality of work life of nurses with standardised training on their work engagement and its impact path, that is, the intermediary role of career identity and job burnout.

BACKGROUND

Most countries currently face the serious problem of a shortage of nurses and this difficulty is likely to persist for a long time. In recent years, some hospitals in China have attempted to try out clinical standardised training for new nurses for a duration of at least two years. They need to cope with clinical work, training assessments, and low salaries. Ways to improve the work input of new nurses play a pivotal role in reducing the turnover rate of nurses.

DESIGN

The current research is a cross-sectional study.

METHODS

Valid questionnaires were received from 245 nurses from the tertiary hospitals between June and July 2021. AMOS was used to conduct a structural equation model to evaluate the mediating effect of burnout and career identity on the association between the quality of work life and work engagement. We describe the study in accordance with the STROBE statement.

RESULTS

The quality of the work life of nurses with standardised training is at a medium to high level (191.62 ± 27.18) and their work engagement is at a relatively high level (75.77 ± 19.60). Quality of work life was negatively correlated with burnout (r₁ = -0.672, p < 0.001) and positively correlated with career identity (r₂ = 0.810, p < 0.001) and work engagement (r₂ = 0.642, p < 0.001). Moreover, a positive relationship was found between the quality of work life and work engagement (β₁ =0.644), which was mediated by burnout and career identity (β₂ =0.144, β₃ =0.218).

CONCLUSIONS

Although the work engagement of nurses with standardised training is encouraging, that work engagement decreases with the increase in the age of nurses, still needs investigation. When nurse managers want to improve the work engagement of new nurses, they should not only pay attention to the quality of work life but take career identity and burnout into consideration.

Exploring the mediating role of methamphetamine use in the relationship between adverse childhood experiences and attempted suicide

OBJECTIVE

Methamphetamine (METH) use and adverse childhood experiences (ACEs) has been associated with an increased risk of suicidal behaviour. However, whether METH use underlies the risk of suicide attributable to ACEs is unknown and warrants investigation to inform preventive interventions. In this study, we examined the mediating role of METH use in the relationship between attempted suicide and ACEs.

METHOD

METH users recruited from a mandatory detoxification center (n = 346) and healthy controls (n = 342) both completed a survey related to 9 types of ACE, which was based the Family Health Questionnaire. A lifetime history of attempted suicide was obtained using the Chinese version of the Composite International Diagnostic Interview. We conducted a bootstrapped mediation analysis to examine the mediating effect of METH use on the association between ACEs and attempted suicide.

RESULTS

Female gender, METH use, and having multiple (≥3) ACEs were associated with an increased risk of attempted suicide. A dose-response relationship between the number of ACEs and suicide rate was observed among individuals with METH use. METH use significantly mediated the association between ACEs and attempted suicide in those with multiple (2 and 3 ACEs respectively with proportion mediated 0.16 and 0.42) and specific types of ACEs (physical abuse, witnessing maternal battering, household substance abuse, sexual abuse, and parental separation with proportion mediated 0.25, 0.35, 0.38, 0.48, 0.47 respectively).

CONCLUSION

Our study is the first to demonstrate that METH use partially mediates the association between ACEs and attempted suicide. Addressing METH use in people with ACEs could reduce their suicide risk.

Pathways linking abdominal obesity to poor memory function: Explore the mediating role of hypertension and depressive symptoms

BACKGROUND

The negative effect of abdominal obesity on cognitive function has been widely reported, especially on memory function, however, it is unclear how the effect is mediated. We aim to investigate the mediating role of hypertension and depressive symptoms.

METHODS

Data were collected from wave 6 (2012-2013) of the English Longitudinal Study of Ageing (ELSA). Abdominal obesity was defined as a waist circumference (WC) ≥88cm for women and ≥102cm for men. Hypertension was determined on the basis of objective blood pressure measurement and previous physician diagnosis. Depressive symptoms were assessed with the 8-item version of the Center for Epidemiologic Studies (CESD) scale. Memory function was measured with the 10-word immediate and delayed recall tests. Baron and Kenny's causal steps and Karlson/Holm/Breen (KHB) method were used to examine the mediating effect.

RESULTS

A total of 7,448 participants aged ≥50 years were included in this study. We found a negative effect of abdominal obesity on memory function (β=-0.047, p=0.031). KHB method identified significant mediating effect of hypertension and depressive symptoms on the relationship between abdominal obesity and memory function, they explained 16.92 and 6.32% of the total effect of abdominal obesity on memory function, respectively.

LIMITATIONS

This study was limited by its cross-sectional design and possibility of residual confounding.

CONCLUSIONS

Hypertension and depressive symptoms might be possible pathways linking abdominal obesity and poor memory function, suggesting that collaborative interventions of abdominal obesity, hypertension and depressive symptoms are beneficial in maintaining memory function.

The relationship between moral sensitivity and professional values and ethical decision-making in nursing students

BACKGROUND

More researchers have paid attention to the ethical decision-making in nursing worldwidely due to the increasing complexity of ethical issues and dilemmas. Ethical decision-making ability is regarded as one of the core competences of nursing practice and has the potential to resolve ethical issues. It is important to identify the key variables related to ethical decision-making and understand their relationship between them respectively. It is also helpful to design interventions to promote nursing students' ability to resolve ethical dilemmas.

OBJECTIVE

This study aims to examine the relationship between moral sensitivity, professional values and ethical decision-making respectively, and to explore whether professional values have mediating effect on the relationship between moral sensitivity and ethical decision-making among nursing undergraduates in Chinese nursing education context.

DESIGN

This study is a cross-sectional descriptive correlational design.

METHODS

263 nursing undergraduates from Nursing and Health School, Zhengzhou University in Henan province of China participated in the study and received the investigation. Their ethical decision-making, moral sensitivity and professional values were measured through the following three questionnaires, including the Judgement About Nursing Decision (JAND), Chinese Moral Sensitivity Questionnaire-Revised Version (MSQ-R-CV) and Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV). The data were processed and analysed by SPSS 23.0 and AMOS 24.0. The statistical methods included descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation analyses and structural equation modeling.

RESULTS

Moral sensitivity is positively correlated with ethical decision-making (P < 0.01). Professional values is positively correlated with ethical decision-making (P < 0.01) and also has a mediating effect on the relationship between moral sensitivity and ethical decision-making (P < 0.01).

CONCLUSION

The investigation contributes to a broader understanding of the factors that influence nursing students' ethical decision-making. Developing ethics education around nursing students' professional values and moral sensitivity can improve their ethical decision-making ability.

Education and grip strength among older Thai adults: A mediation analysis on health-related behaviours

Abstract.

BACKGROUND

Previous studies have investigated the effect of differential educational attainment at younger ages on health disparities among older adults, but how such an effect can be attenuated remains understudied. This study examines the mediating effects of four health-related behaviours, namely smoking, alcohol drinking, healthy eating, and physical activity, on the relationship between older adults' education and grip strength.

METHODS

The study used data from 7,064 individuals aged 60 years and older who participated in the 2009 National Health Examination Survey of Thailand. To examine the relationships among education, health behaviours, and grip strength, multivariate regressions were performed following Baron and Kenny's approach. Generalized Structural Equation Modelling (SEM) was utilized to quantify the mediating effects.

RESULTS

All else being equal, education is positively associated with stronger grip for both genders. The mediation analyses demonstrate that health-related behaviour plays an important role in the relationship between education and grip strength; however, the extent to which it mediates the effect of education varies with the type of health behaviour and between genders. Not smoking and engaging in physical activity can partly explain the relationship between education and grip strength in older men. Meanwhile, the consumption of fruits and vegetables and participation in regular physical activity significantly mediate the effect of education on grip strength in older women.

CONCLUSION

Our study reaffirms the importance of educational opportunity in earlier life and recommends health-related behavioural modifications to improve health status in low-educated older adults.

Influence of familiarity with traffic regulations on delivery riders' e-bike crashes and helmet use: Two mediator ordered logit models

Micro-mobility vehicles such as electric bicycles, or e-bikes, are becoming one of the essential transportation modes in metropolitan areas, and most deliveries in large cities are dependent on them. Due to the e-bike's popularity and vulnerability, e-bike crash occurrence has become a major traffic safety problem in many cities across the world; finding the most important human factors affecting e-bike safety has thus been an important recent issue in traffic safety analysis. Since delivery riders are a key group of e-bike users, and since helmet use plays a crucial role in reducing the severity of a crash, this study conducted a city-wide online survey to analyze the helmet usage of 6,941 delivery riders in Shanghai, China. To determine the in-depth mechanisms influencing helmet use and e-bike crash occurrence, including the direct and indirect effects of the relevant factors, two mediator ordered logistic regression models were employed. The mediator ordered logistic model was compared with the traditional logistic regression model, and was found to be superior for modeling indirect as well as direct influencing factors. Results indicate that riders' familiarity with traffic regulations (FTR) is an extremely important variable mediating between the independent variables of riders' educational level and age, and the dependent variables of helmet use and e-bike crashes. Improving riders' FTR can consequently increase helmet use and decrease crash occurrence. Authorities can apply these findings to develop appropriate countermeasures, particularly in legislation and rider training, to improve e-bike safety.

The mediating effect of self-compassion on the relationship between childhood maltreatment and depression

BACKGROUND

Depression is the leading cause of suicide. Childhood maltreatment is an important influencing factor for depression in adulthood. However, the mediating effect of self-compassion between childhood maltreatment and depression has not yet been explored.

METHODS

A cluster random sampling of 4189 students was selected from a university in Hebei Province, China. They completed the Childhood Trauma Questionnaire-Short Form, the Self-Compassion Scale, and the Self-Rating Depression Scale.

RESULTS

Depression is significantly positively correlated with childhood maltreatment and its subscales, including emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Childhood maltreatment can affect depression not only directly, but also indirectly through self-compassion and its components of self-kindness, the sense of common humanity, and mindfulness.

LIMITATIONS

Potential sampling bias, subjective measures, and the cross-sectional design are the main limitations.

CONCLUSION

Self-compassion partly plays a mediating role between childhood maltreatment and depression. College educators and clinicians should actively help college students who experienced abuse during childhood to increase their level of self-compassion to reduce their depression.

Influences of Public Medical Insurance System on Labor Health Status and Supply

BACKGROUND

The emergence of COVID-19 in 2020 has brought dramatic impacts to the global economy. The resulting health crisis and widespread fear have triggered labor shortage problems such as high job vacancy rate and low labor participation rate. Thus, how to increase the labor supply has become a hotspot among scholars. We aimed to analyze the influences of public medical insurance system on labor health status and supply.

METHOD

Using the China Health and Nutrition Survey five-phase panel data, the new rural cooperative medical system was taken as an example to empirically analyze the influences of public medical insurance system on the individual health status and labor supply via the panel Tobit model and panel binary Logit model. The analysis revealed the mediating effect of health status.

RESULTS

First, Public medical insurance system could significantly improve individual health status. Second, public medical insurance system will lengthen the labor supply time and elevate the labor supply rate by improving individual health status. Third, the influences of public medical insurance system on labor health status and supply vary with gender and age.

CONCLUSION

Public medical insurance system will generate positive influences on labor health status and labor supply. Hence, perfecting the public medical insurance system is able to mitigate the negative impacts of population aging and pandemic on the labor supply.

The impact of FDI on environmental pollution in China: evidence from spatial panel data

With the rapid development of the economy, China's environmental problems remain prominent, and ecological environmental protection has far to go. Many factors work together to affect environmental pollution. In this study, based on the spatial correlation of environmental situation between adjacent regions, spatial autoregressive models are constructed to examine the impacts of foreign direct investment (FDI) on environmental pollution in China. We find an inverted U-shaped relationship between FDI and environmental situation. The study further investigates the mediating effect of economic scale, technology, and industrial structure between FDI and environmental situation. The results show that regions with a larger economic scale and better industrial structure experience a greater FDI impact on environmental situation, but technological level does not serve as a moderator in this study. Our findings have important implications for environmental pollution control and provide important insights for China into a new stage of high-quality development.

The mediating role of emotion regulation strategies in the relationship between family of origin violence and intimate partner violence

The effects of family of origin violence and intimate partner violence have been extensively documented; however, very few studies have examined the interaction with emotion regulation strategies. Thus, the objective of this research was to analyze whether different types of emotion regulation strategies, both adaptive and maladaptive, mediate the relationship between family of origin violence and intimate partner violence in the Mexican population. A total of 838 participants (45.9% men and 54.1% women) responded to instruments addressing family of origin violence, emotion regulation strategies, and intimate partner violence. The results revealed that both structural models were significant. For women, the model showed an adequate fit X2 (11, N = 838) = 22.75, p = .288, GFI = .95, AGFI = .91, NFI = .98, CFI = .97, RMSEA = .05. Likewise, we found similar indexes for men X2 (11, N = 838) = 28.20, p = .348, GFI = .97, AGFI = .93, NFI = .97, CFI = .95, RMSEA = .04. Specifically, the direct effects of adaptive strategies on intimate partner violence were statistically significant. Meanwhile, the direct effects of family of origin violence on maladaptive emotion regulation strategies were significant, as were the direct effects of maladaptive strategies on intimate partner violence. In turn, the indirect effects of family of-origin violence were significantly related to intimate partner violence via maladaptive emotion regulation strategies. In addition, the results clearly showed that men reported higher levels of aggression against women. Finally, regarding the selection of emotion regulation strategies, while women employed more adaptive emotion regulation, men showed a more definite tendency to use maladaptive emotion regulation.

How do corruption and energy efficiency affect the carbon emission performance of China's industrial sectors?

Existing research on the relationship among corruption, energy efficiency, and industrial carbon emissions is limited, while incorporating them into one analytical framework might provide new insights for the mechanism between corruption and industrial carbon emissions. Using the provincial panel data in China's industry from 2005 to 2015, this study applies the System Generalized Method of Moments (SYS-GMM) to explore the impacts of corruption and energy efficiency on industrial carbon emissions. The results indicate that under current economic development status, the effects of corruption and energy efficiency on industrial carbon emissions are divergent; i.e., corruption can enhance carbon emissions, whereas energy efficiency facilitates carbon emission reduction. Energy efficiency plays a mediating role in the relationship between corruption and carbon emissions for both the whole sample and the sub-samples. In other words, corruption aggravates industrial carbon emissions through lowering energy efficiency. Additionally, for the eastern region in China, there is an inverted U-shaped curve relationship between corruption and carbon emissions, as well as a U-shaped curve relationship between energy efficiency and carbon emissions. For the other regions, there is little sign of nonlinearity. Based on the results, policy implications regarding carbon emissions curbing are proposed.

Mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia: a cross-sectional study

BACKGROUND

Functional degradation among community-dwelling patients with schizophrenia can negatively influence their recovery. Given the importance of patient empowerment during recovery, this study examined the mediating effect of empowerment on the relationship between global function and personal recovery among community-dwelling patients with schizophrenia.

METHODS

This cross-sectional study recruited community-dwelling patients with schizophrenia from northern and central Taiwan. Questionnaires with verified reliability and validity were provided and collected on site by trained nurses. Global function, empowerment, and personal recovery were measured using the Global Assessment of Functioning (developed by the American Psychiatric Association), Empowerment Scale, and Questionnaire on the Process of Recovery, respectively. The causal steps approach proposed by Baron and Kenny and the Sobel test were utilized to verify the mediation effect. The causal steps approach tested the four following pathways (regression coefficients): global function on empowerment (Path a), global function and empowerment as predictors of personal recovery (Path b), global function on personal recovery (Path c), and global function and empowerment on personal recovery (Path c').

RESULTS

A total of 373 participants completed the survey. After controlling for factors associated with recovery, Paths a (β = .24, p < .001), b (β = .68, p < .001), and c (β = .19, p < .001) were found to be significant; however, Path c' was not significant (β = .03, p = .452). Empowerment was determined to exert "full mediation" over the effects of global function on personal recovery, and the Sobel test indicating significant mediation (Z = 3.61, p < .001).

CONCLUSIONS

Empowerment fully mediates the association between global function and personal recovery. This study suggested that offering empowerment-oriented care services may be more effective than global function improvement in recovery among these patients.

Violence Victimization and Condomless Anal Intercourse Among Transgender Women in China: Mediating Role of Depression

Transgender women (TGW) worldwide report disproportionate violence victimization, depression and condomless anal intercourse (CAI), but the mechanism of the coexistence remains unclear. Using snowball sampling, we recruited 198 self-identified TGW in Shenyang, China between April 2017 and July 2017, and conducted confidential questionnaire survey among them. Positive HIV status was reported by 49 (24.7%) participants. 117 (59.1%) reported at least one type of lifetime violence victimization, with transactional sexual partners being the main violence perpetrators. 108 (54.5%) reported mild to severe depression. 105 (53.0%) reported having CAI with their sexual partners during the last 6 months. Path analysis showed that the association between participants' violence victimization and CAI was fully mediated by their depression (indirect effect: 0.083, p = 0.014; direct effect: 0.137, p = 0.121). We suggest to incorporate violence screening and prevention and mental health services into intervention strategies to prevent CAI among Chinese TGW.

Analysing the main and interaction effects of commercial vehicle mix and roadway attributes on crash rates using a Bayesian random-parameter Tobit model

In previous research, the effects of commercial vehicle proportions (CVP) on overall crash propensity have been found to be significant, but the results have been varied in terms of the effect direction. In addition, the mediating or moderating effects of roadway attributes on the CVP-vs-safety relationships, have not been investigated. In addressing this gap in the literature, this study integrates databases on crashes, traffic, and inventory for Hong Kong road segments spanning 2014-2017. The classes of commercial vehicles considered are public buses, taxi, and light-, medium- and heavy-goods vehicles. Random-parameter Tobit models were estimated using the crash rates. The results suggest that the CVP of each class show credible effects on the crash rates, for the various crash severity levels. The results also suggest that the interaction between CVP and roadway attributes is credible enough to mediate the effect of CVP on crash rates, and the magnitude and direction of such mediation varies across the vehicle classes, crash severity levels, and roadway attribute type in four ways. First, the increasing effect of taxi proportion on slight-injury crash rate is magnified at road segments with high intersection density. Second, the increasing effect of light-goods vehicle proportion on slight-injury crash rate is magnified at road segments with on-street parking. Third, the association between the medium- and heavy-goods vehicle proportion and killed/severe injury (KSI) crash rate, is moderated by the roadway width (number of traffic lanes). Finally, a higher proportion of medium- and heavy-goods vehicles generally contributes to increased KSI crash rate at road segments with high intersection density. Overall, the findings of this research are expected not only to help guide commercial vehicle enforcement strategy, licensing policy, and lane control measures, but also to review existing urban roadway designs to enhance safety.

Associations of Sleep Quality with Gait Speed and Falls in Older Adults: The Mediating Effect of Muscle Strength and the Gender Difference

INTRODUCTION

Although previous studies have reported the significant associations of sleep quality with gait speed and falls, the mechanisms underlying these associations are unclear. We aimed to examine the gender-specific associations of sleep quality with gait speed and falls among older adults and to explore the possible mediating effect of muscle strength on these relationships.

METHODS

Data were taken from wave 6 (2012-2013) of the English Longitudinal Study of Aging (ELSA), including 7,664 participants aged 60 years and older. Sleep quality and falls were assessed by self-report. Gait speed was measured by the "timed walking test" and then adjusted by height. As an indicator of overall muscle strength, grip strength was measured by using the Smedley dynamometer. Baron and Kenny's causal steps and the Karlson/Holm/Breen method were used to examine the mediating effect.

RESULTS

Higher sleep quality was associated with the higher level of gait speed (β = 0.008, p = 0.031 in men; β = 0.008, p = 0.017 in women) and with lower prevalence of falls (OR = 0.878, 95% CI: 0.773, 0.998 in men; OR = 0.874, 95% CI: 0.792, 0.965 in women). Grip strength mediated these associations in men but not in women, and the mediating effects of grip strength can explain 23.74 and 11.01% of the total effect of sleep quality on gait speed and falls, respectively.

CONCLUSION

Our findings help explain the mechanism underlying the associations of sleep quality with gait speed and falls. Effort to maintain the mobility of the older men should focus on improving both sleep quality and muscle strength.

Visual-spatial skills contribute to Chinese reading and arithmetic for different reasons: A three-wave longitudinal study

Previous literature has revealed that visual-spatial processing is associated with both reading and arithmetic. Yet the strength of their relations and the reasons why visual-spatial processing contributes to reading and arithmetic remain ambiguous. The current study focused on two types of visual-spatial skills that recent evidence has suggested are crucial in children's early reading and arithmetic development: visual-perceptual and spatial visualization skills. With an interval of 6 months, we assessed 104 Hong Kong kindergarten children's visual-spatial skills, word reading, arithmetic performance, and vocabulary knowledge at Wave 1; orthographic awareness, basic number knowledge, and number line estimation at Wave 2; and Chinese word reading and arithmetic performance at Wave 3. Correlational analysis showed that both visual-perceptual and spatial visualization skills were associated with later Chinese word reading and arithmetic performance. Further mediation analyses revealed that spatial visualization skills, rather than visual-perceptual skills, contributed to Chinese word reading via orthographic awareness and also predicted arithmetic performance through basic number knowledge. However, number line estimation failed to mediate any relations of visual-spatial skills with children's arithmetic abilities. The results suggest the importance of visual-spatial processing in Chinese word reading and mathematics, with spatial visualization contributing to reading and mathematics for different reasons.

Relationship Between Frailty and Depression Among Community-Dwelling Older Adults: The Mediating and Moderating Role of Social Support

BACKGROUND AND OBJECTIVES

Frailty is associated with depression in older adults and reduces their social support. However, the mechanism underlying such relationship remains unclear. We aim to examine whether social support acts as a mediator or moderator in the relationship between frailty and depression.

RESEARCH DESIGN AND METHODS

This cross-sectional study was conducted among 1,779 community-dwelling older adults aged 60 and older. Frailty, social support, and depressive symptoms were measured by the Physical Frailty Phenotype, Social Support Rating Scale, and five-item Geriatric Depression Scale, respectively. Data were also collected on age, gender, years of schooling, monthly income, cognitive function, number of chronic diseases, physical function, and pain.

RESULTS

Linear regression models showed that subjective support and support utilization, but not objective support, mediated and moderated the relationship between frailty and depressive symptoms. The Johnson-Neyman technique determined a threshold of 30 for subjective support, but not for support utilization, beyond which the detrimental effect of frailty on depressive symptoms was offset.

DISCUSSION AND IMPLICATIONS

Social support underlies the association of frailty with depression, and its protective role varies by type. Interventions on depression should address improving perceptions and utilization of social support among frail older adults rather than simply providing them with objective support.

Social Support and Tinnitus Distress: The Importance of Developing Positive Psychological Qualities in Patients with Chronic Tinnitus

INTRODUCTION

The role of social support in the relief of tinnitus distress and related mechanisms remains unclear. This study aimed to confirm a hypothesis that the influence of social support on tinnitus distress is mediated by resilience and self-esteem.

METHODS

The Social Support Rating Scale, Connor-Davidson Resilience Scale, Positive Version of Rosenberg Self-Esteem Scale, and Tinnitus Handicap Inventory were used to assess 296 patients who experience chronic subjective tinnitus. The collected data were subjected to correlational analysis, mediating effect testing, and structural equation model analysis using R 3.3.1 with the mediate and lavaan packages.

RESULTS

The result showed that social support had significant positive correlations with resilience and self-esteem, while resilience and self-esteem had significant negative correlations with tinnitus distress. Furthermore, social support indirectly affected tinnitus distress through the full mediating effects of resilience and self-esteem and could indirectly affect resilience through the partial mediating effects of self-esteem.

CONCLUSION

These results suggested that the key to social support for alleviating tinnitus distress lies in the development of patients' resilience and self-esteem. Promoting the development of positive psychological quality of tinnitus patients and improving their perception of social support may become the new approaches of clinical management of tinnitus.

Urban carbon emission intensity under emission trading system in a developing economy: evidence from 273 Chinese cities

The international community has generally recognized the key role of developing countries' cities in reducing carbon emissions, an elemental way to mitigate climate change. However, few have empirically analyzed the impact of market-based instruments such as emission trading system on urban carbon emissions in developing economies. This paper examines the effect of China's pilot carbon trading markets, the first emission trading system in developing economies, on cities' carbon intensity. We also explore the mechanism by which the emission trading system achieves its influence. The PSM-DID method is used to analyze the panel data including China's 273 prefecture-level cities from 2010 to 2016. The results illustrate that the emission trading system significantly decreased pilot cities' carbon intensity and this effect endured; as time progressed, the reduction effect was increasing. Through mediating effect analysis, we find that the emission trading system reduced the carbon intensity via increasing the proportion of tertiary industry output value in GDP and decreasing the energy intensity. Overall, the empirical results suggest that the Chinese government should drive the establishment and improvement of a national carbon market, proactively adjust industry structure, and consider the possible influence caused by the potential energy rebound effect.

The mediating role of cognition in the relationship between sleep duration and instrumental activities of daily living disability among middle-aged and older Chinese

OBJECTIVE

To explore the effect of sleep duration at baseline on the incident IADL disability among middle-aged and older Chinese, and test whether cognition mediates this causality.

METHODS

Data were collected from wave 1 (2011-2012) to wave 3 (2015-2016) of the China Health and Retirement Longitudinal Study (CHARLS). Sleep duration was self-reported at baseline. Cognitive function, including episodic memory and mental intactness were measured via a questionnaire. IADL was assessed at baseline and follow-up. Baron and Kenny's causal steps and Karlson/Holm/Breen (KHB) method were conducted to examine the mediating effect.

RESULTS

A total of 10,328 participants free of IADL disability at baseline were included in this study. Over 4 years of follow-up, 17.1% of participants developed IADL disability. Compared to 7-8 h sleep duration, both short sleep (OR=1.460; 95% CI: 1.261-1.690 for sleeping ≤5 h; OR= 1.189; 95% CI: 1.011-1.400 for sleeping 5-7 h) and long sleep (OR=1.703; 95% CI: 1.269-2.286 for sleeping >9 h) were linked with incident IADL disability. KHB method identified significant mediating effect of cognition on the relationship between extreme sleep durations (≤5 h or >9 h) and IADL disability and the proportional mediation through cognition was 21.32% and 21.06% for sleeping ≤5 h and >9 h, respectively.

CONCLUSION

Both short (sleeping ≤5 h) and long sleep duration (sleeping >9 h) predicted incident IADL disability. Cognition partially mediated the effect of extreme sleep durations on IADL disability.

The impact of heterogeneous environmental regulation on innovation of high-tech enterprises in China: mediating and interaction effect

It is important for China's green innovation productivity and sustainable development to study the effect of heterogeneous environmental regulation on microenterprise innovation activities. Based on the panel data of high-tech enterprises in China from 2012 to 2017, the article studies the incentive effect of heterogeneous environmental regulation on technological innovation and the mediation of innovation input and explores whether different types of environmental regulations have interactive effects on enterprise innovation. The results reveal that compared with the command-controlled environmental regulation, the incentive effect of market-incentive environmental regulation and voluntary environmental regulation on enterprise innovation is more significant, where the innovation input fully plays its role as a mediating effect. Further research finds that there is an interactive effect between command-controlled environmental regulation and other two regulatory tools, but no interactive effect between market-incentive environmental regulation and voluntary environmental regulation, which shows that the control-based regulatory tools and more flexible regulatory tools have a complementary effect on enterprise innovation. Through revealing the internal mechanism of environmental regulation on enterprise innovation, the article displays the process of technological innovation, and it also finds that flexible regulation tools and the combination of rigid and flexible tools are more conducive to encourage enterprises to carry out innovation activities.

Hypermethylation of WNT3A gene and non-syndromic cleft lip and/or palate in association with in utero exposure to lead: A mediation analysis

OBJECTIVES

We aim to investigate association between WNT3A methylation and risk of non-syndromic cleft lip and/or palate (NSCL/P), and examine mediating effect of WNT3A methylation on the association of NSCL/P and lead (Pb) exposure in fetuses.

METHODS

DNA methylation of WNT3A in umbilical cord blood was determined among 59 NSCL/P cases and 118 non-malformed controls. Mediation analysis was performed to evaluate the potential mediating effect of WNT3A methylation on association between concentrations of Pb in umbilical cord and risk for NSCL/P. Additionally, an animal experiment in which cleft palates were induced by lead acetate was conducted.

RESULTS

The overall average methylation level of WNT3A was significant higher in NSCL/P cases as compared to controls. The risk for NSCL/P was increased by 1.90-fold with hypermethylation of WNT3A. Significant correlation was observed between concentrations of Pb in umbilical cord and methylation level of WNT3A. The hypermethylation of WNT3A had a mediating effect by 9.32% of total effect of Pb on NSCL/P risk. Gender-specific association between WNT3A methylation and NSCL/P was observed in male fetuses, and the percentage of the mediating effect increased to 14.28%. Animal experiment of mice showed that maternal oral exposure to lead acetate may result in cleft palate in offspring.

CONCLUSION

Hypermethylation of WNT3A was associated with the risk for NSCL/P and may be partly explain the association between exposure to Pb and risk for NSCL/P. The teratogenic and fetotoxic effects of Pb were found in mice.

Exposure to organophosphate ester flame retardants and plasticizers during pregnancy: Thyroid endocrine disruption and mediation role of oxidative stress

Organophosphate esters (OPEs) are widely used as flame retardants and plasticizers in consumer and industrial products. Human exposure to OPEs raises concerns due to their endocrine disruptive potentials. Till now, the effects of OPEs on thyroid hormones (THs) and the mediating role of oxidative stress in pregnant women have not been studied. In this study, prenatal urinary concentrations of OPE metabolites (mOPEs), levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and oxidative stress levels of 8-hydroxy-2-deoxy guanosine (8-OHdG) and malondialdehyde (MDA) were measured in pregnant women (n = 360) from a coastal urbanized region and moderate socioeconomic status. Neonatal TSH in heel blood was also measured in newborns (n = 309). Dibutyl phosphate (DBP) and diphenyl phosphate (DPHP) were extensively detected with a median creatinine-adjusted level of 0.19 μg/g and 0.66 μg/g, respectively, and the median of ∑mOPEs was 1.82 μg/g. DBP and DPHP were included in the analysis. The concentrations of DBP and DPHP were positively associated with either maternal or neonatal TSH levels, while not for maternal FT3 and FT4 levels. Positive associations for maternal and neonatal TSH were particularly observed in girls as stratified by newborn sex suggesting a sex-selective difference. Furthermore, 8-OHdG, the biomarker of DNA damage, was found to be a major mediator (>60%) for the association between neonatal TSH and DPHP, suggesting that DNA damage is involved in fetal thyroid function disruption. On the other hand, MDA showed a partially suppressing effect (<40%) for the associations between mOPEs and neonatal TSH, which needs further clarification. For maternal TSH, both 8-OHdG and MDA showed moderate mediating effects while the direct effects of mOPEs on maternal TSH also contributed. These results suggest thyroid disrupting effects of OPE exposure on mothers and fetuses during pregnancy and the potential influence mediated by the oxidative stresses of DNA damage and lipid peroxidation.

Greenness surrounding schools and adiposity in children and adolescents: Findings from a national population-based study in China

BACKGROUND

Previous studies have indicated that exposure to green space may benefit human health. However, the available evidence concerning the effects of greenness, especially school-based greenness, on pediatric obesity is scarce.

OBJECTIVE

To explore the association between school-based greenness and adiposity in children and adolescents in China.

METHOD

We conducted a nationwide cross-sectional study of 56,620 children and adolescents (aged 6-18 years) in seven provinces/municipalities across China. School-based greenness was assessed using satellite-derived Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) within 100-, 500-, and 1000-m circular buffers around each school's address. Generalized linear mixed regression models were used to estimate associations of greenness with BMI z-scores (zBMI), waist circumference, and prevalent overweight/obesity. We also explored the potential mediating role of ambient air pollution and physical activity in the greenness-adiposity associations.

RESULT

In the adjusted model, an IQR increase in NDVI_-1000m was associated with lower zBMI (β: -0.11, 95% confidence interval[CI]: -0.13,-0.09) and waist circumference (β: -0.64, 95%CI: -0.78,-0.50). Consistently, an IQR increase in NDVI_-100m, NDVI_-500m, NDVI_-1000m was associated with 7-20% lower odds of overweight/obesity in the adjusted models. Air pollutants mediated 6.5-29.1% of the association between greenness and zBMI. No significant mediation effect was observed for physical activity.

CONCLUSION

Higher school-based greenness levels were associated with lower zBMI, waist circumference, and lower odds of overweight and obesity in children and adolescents. Ambient air pollutants may partially mediate the greenness-adiposity associations.

Mediating effect of behavioural intention on podcast acceptance

This research contributes to knowledge in mediating effect of lecturers' behavioural intention towards the acceptance of podcasts technology in universities. A cross-sectional quantitative research design was involved in this study. Also, a total of eight hundred and twenty-nine (829) lecturers participated in this research from three different south-west Nigeria Federal universities. The research instrument was titled lecturer's acceptance questionnaire (LAQ) with a calculated Cronbach's alpha of .919, which confirmed the instrument validity. The gathered data was analysed by using both descriptive and inferential statistics. The formulated hypothesis was tested at .05 level of significance. The result from descriptive analysis of data suggested that behavioural intention was at a low level among lecturers and the results of hypothesis testing revealed the effect of behavioural intention as partial mediator of podcast acceptance. Based on these findings relevant conclusions and recommendations were suggested in this research.

Assessment on the effectiveness of environmental regulation in China-evidence from a panel data analysis

In the context of global warming and environmental deterioration, the environment impact assessment is a crucial institutional guaranty to assure less or no pollution during the process of the economic growth and rapid social development. This paper selected the environmental regulation system in China as a research target and assesses the effectiveness of green tax on the environment through an empirical analysis. The panel data from 2005 to 2015 in different cities in China are employed to analyze with a two-way fixed regression model; it analyzes the impact of environmental instruments like resource tax, excise tax, vehicle purchase tax, and pollutant discharge fees on environmental pollution and finds that the modeling conditions with green tax reform can lead to higher effect on environmental pollutant constrain but is distributed differently among east, central, and west based on the empirical analysis in China. Moreover, resource tax has a significant effect in the east and midwest of China. The effectiveness of excise tax on integrated pollution is not statistically significant. Compared with the midwest, eastern China's green tax had a much better performance on reducing environmental pollution. Pollutant discharge fees indicates a significant negative correlation to integrated pollution. The consumption of the other goods (like meat consumption) plays a mediating effect between vehicle purchase tax and integrated environmental pollution. In addition, the relevant policy recommendations are proposed against different tax types.

The mediating effect of air quality on the association between human mobility and COVID-19 infection in China

BACKGROUND

Previous studies have found that human mobility restrictions could not only prevent the spread of COVID-19, but also improve the air quality because of the reduction of industrial production, transportation and traffic. It is noteworthy that air quality is also closely related to the risk of COVID-19 infection. Therefore, we aimed to assess the mediating role of air quality on the association between human mobility and the infection caused by this novel coronavirus.

METHODS

We collected daily confirmed cases, human mobility data, air quality data and meteorological variables in 120 cities from China between January 23, 2020 and February 29, 2020. We applied the generalized additive model to examine the association of human mobility index with COVID-19 confirmed cases, and to assess the mediating effects of air quality index and each pollutant.

RESULTS

We observed a significant positive relationship between human mobility index and the daily counts of COVID-19 confirmed cases. A unit increase in human mobility index (lag0-14) was associated with a 6.45% increase in daily COVID-19 confirmed cases, and air quality index significantly mediated 19.47% of this association. We also observed a positive relationship between human mobility index and air quality index. In the pollutant level analyses, we found significant mediating effects of PM2.5, PM10, and NO2.

CONCLUSIONS

Our study suggests that limiting human movements could reduce COVID-19 cases by improving air quality besides decreasing social contact.

Maternal autonomy and high-risk pregnancy in Bangladesh: the mediating influences of childbearing practices and antenatal care

BACKGROUND

Maternal, infant and neonatal mortality rates are high in Bangladesh. Certain childbearing practices and poor utilisation of antenatal care services make Bangladeshi women more vulnerable to experience poor health during pregnancy and adverse pregnancy outcomes. Also, women in Bangladesh remain considerably subordinate to men in almost all aspects of their lives, from education and work opportunities to healthcare utilisation. This study investigates the severity of health complications during pregnancy in relation to women's autonomy, and how childbearing practices and utilisation of antenatal care mediate this relationship.

METHODS

Data from the most recent Bangladesh Demographic and Health Survey (BDHS) is used in this study. Multinomial regression models (MLRM) are employed to examine the relationship between the outcome variable - high risk pregnancy, and explanatory variables - women's autonomy, childbearing practices and use of antenatal care.

RESULTS

In Bangladesh, about 41.5% of women experienced high-risk pregnancies involving multiple health complications. Findings showed that women's autonomy in decision-making, freedom of movement and economic autonomy were significantly associated with high-risk pregnancies. However, women's autonomy in physical mobility in particular did so only through the mediating factors of maternal childbearing practices and antenatal care. Specifically, both early and delayed childbearing and shorter birth interval increased the likelihood of high-risk (multiple complications) pregnancies by about 30% and 31% respectively, high parity increased the risk by 23% and use of antenatal care decreased it by 46%.

CONCLUSIONS

The Women's decision-making autonomy, freedom of movement and economic autonomy had significant effects on high-risk pregnancies. However, the effects were mediated by both maternal childbearing practices and use of antenatal care in a limited way. Policies and programmes aimed at improving pregnancy outcomes need to focus on all three sets of factors: women's autonomy, childbearing practices and use of antenatal care.

Psychological resilience, self-acceptance, perceived social support and their associations with mental health of incarcerated offenders in China

OBJECTIVES

We aimed to analyze the mental health status of incarcerated offenders in the detention centers and related factors; and introduce psychological resilience, self-acceptance and perceived social support for further analyses, to explore the relationships between them and mental health in these special populations.

METHODS

Incarcerated offenders in two detention centers of Guangdong province were recruited. General demographic questionnaire, Self-acceptance Questionnaire (SAQ), Perceived Social Support Scale (PSSS), Connor and Davidson Resilience Scale (CD-RISC) and General Health Questionnaire (GHQ-20) were addressed to the participants for investigation. Pearson correlation analysis, multiple linear regression and Structural Equation Modeling (SEM) were used to identify the associations and related factors.

RESULTS

Scores for GHQ-20, CD-RISC, SAQ and PSSS were 7.72 ± 4.49, 57.85 ± 17.30, 40.94 ± 5.40 and 42.99 ± 9.90, respectively. Some socio-demographic factors influenced significantly to the mental health status. After adjusting for socio-demographic factors, the scores of self-acceptance (B = -0.23, P < 0.001), perceived social support (B = -0.10, P < 0.001) and psychological resilience (B = -0.06, P < 0.001) were negatively associated with scores of mental health. Further SEM analyses suggested self-acceptance and resilience had not only mediating effects respectively, but also multiple mediating effects between perceived social support and mental health (r = -0.11, P < 0.01; r = -0.12, P < 0.01; r = -0.04, P < 0.01).

CONCLUSION

The levels of mental health, psychological resilience, self-acceptance and perceived social support among incarcerated offenders are generally low, and influenced by socio-demographic factors. In addition, self-acceptance, perceived social support and resilience are protective factors for mental health status of offenders; and self-acceptance and resilience mediate the association between perceived social support and mental health.

Mediating effect of hope level between psychological pain and quality of life in patients on chemotherapy for esophageal cancer

BACKGROUND

Esophageal cancer (EC) seriously endangers the life and health of patients, and the physical and psychological pain due to gastrointestinal and other adverse reactions caused by chemotherapy rarely attracts the attention of medical staff and family members. Hope is a kind of dynamic psychological energy, which can effectively alleviate the influence of risk factors on mental health, and is an important psychological resource for individuals to cope with stress. Therefore, this study investigated the relationship between psychological pain, hope level, and quality of life in patients on chemotherapy for EC, in order to provide an objective basis for appropriate clinical psychological intervention.

AIM

To explore the mediating effect of hope level between psychological pain and quality of life in patients with EC on chemotherapy, so as to provide a basis for psychological management of patients with EC.

METHODS

The psychological pain thermometer, Herth hope scale, and quality of life scale were used to investigate the psychological pain, hope level, and quality of life in 80 patients with EC on chemotherapy by convenient sampling method.

RESULTS

The psychological pain score of the 80 patients was 2.98 ± 0.65, among which no psychological pain accounted for 20.0% (16/80), mild psychological pain accounted for 40.0% (32/80), and significant psychological pain accounted for 40.0% (32/80). The score of hope level was 34.98 ± 4.65, and the score of quality of life was 103.56 ± 18.47. Pearson analysis showed that the patient's hope level was negatively correlated with the degree of psychological pain (P < 0.01) and positively correlated with the quality of life (P < 0.01), while psychological pain was negatively correlated with the quality of life (P < 0.01). Mediating effect variance analysis showed that the hope level had a partial mediating effect between psychological pain and overall quality of life, emotional state, and functional state (P < 0.05).

CONCLUSION

Psychological distress and hope level both affect the quality of life in patients with EC on chemotherapy, and hope level in patients with EC on chemotherapy plays an intermediary role between psychological distress and quality of life. Psychological pain and hope level assessment should be enhanced in clinical work, and measures should be taken to improve the level of hope, reduce psychological distress, and thus improve patients' quality of life.

The role of collective efficacy and co-regulation in medical students' performance in small group contexts

PURPOSE

This study investigated the role of collective efficacy and co-regulation in terms of students' performance during small group projects in a medical research program. The effect of collective efficacy in student performance was expected to be mediated by co-regulation.

METHODS

A total of 50 students who enrolled in a medical research program worked on their medical research project in small groups over a period of 9 weeks. After they had submitted their final research project reports as groups at the end of the course, the collective efficacy and co-regulation surveys were conducted online.

RESULTS

The mediation model was significant and explained 26.61% of the variance in student performance. The total effect of collective efficacy on student performance was significant and the indirect effect through co-regulation was also significant.

CONCLUSION

These results suggest that collective efficacy influenced student performance through co-regulation in group learning contexts. Considering the fact that more and more collaborative learning now occurs in medical education, the result of this study can provide significant insights for enhancing students' performance in small group contexts.

Being beneficial to self and caregiver: the role of dispositional mindfulness among breast cancer patients

PURPOSE

Breast cancer (BC) patients report complex negative emotions, including symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD). What's more, being diagnosed with cancer also has a negative impact on the patient's family such as additional financial burden and care needs, leading to higher levels of caregiver burden. This study aimed to explore whether dispositional mindfulness could alleviate multiple negative emotions of BC patients and to investigate the mediating effect of caregiver burden on the relationship between the patients' dispositional mindfulness and negative emotions.

METHODS

A sample of 230 Chinese BC patients receiving chemotherapy and their caregivers voluntarily participated in the study by completing a set of questionnaires including the Mindfulness Attention Awareness Scale, the Caregiver Self-assessment Questionnaires, the General Anxiety Symptoms Scale, the Patient Health Questionnaire, and the PTSD Symptom Scale. Structural equation modeling was used to test the relationship between dispositional mindfulness, negative emotions, and caregiver burden.

RESULTS

Dispositional mindfulness was significantly and negatively correlated with negative emotions, including anxiety, depression, and PTSD among the BC patients. Structural equation modeling showed that caregiver burden mediated the relation between patients' dispositional mindfulness and negative emotions.

CONCLUSION

BC patients with higher levels of dispositional mindfulness showed less negative emotions. The results of the mediation analysis suggested that higher levels of dispositional mindfulness of breast cancer patients could decrease the caregivers' perceived burden and, in turn, relieve patients' negative emotions. Dispositional mindfulness was beneficial to breast cancer patients as well as their caregivers, indicating that mindfulness-based interventions targeting distress in patient-caregiver dyads would be more effective than what interventions for patients alone.

Does environmental information disclosure contribute to improve firm financial performance? An examination of the underlying mechanism

Given the widespread impacts of firm activities on the environment, firms are increasingly required to disclose environmental information. However, the relation between environmental information disclosure and firm financial performance is controversial and the mechanism through which environmental information disclosure affects financial performance is insufficiently investigated. This research examined the effect of environmental information disclosure on financial performance and explored the mediating effects of visibility (e.g., analyst coverage and institutional ownership) and liquidity. Panel data from 289 Chinese listed firms were analyzed with the assistance of STATA Software. The results revealed that environmental information disclosure positively (directly) affects financial performance. Further, environmental information disclosure also indirectly affects financial performance via analyst coverage (e.g., number of analysts and number of reports) and liquidity. Analyst coverage and liquidity mediate the relationship between environmental information disclosure and financial performance while institutional ownership has no mediating effect. According to the results, practical implications were discussed and future research directions were noted.