Influence of technical, cognitive and socio-emotional factors on digital literacy in nursing students assessed using structural equation modeling

BACKGROUND

Digital literacy is one of the 21st-century skills that nursing students should develop and acquire. Several factors influencing digital literacy have been identified, but the predictive role of technical, cognitive, and socio-emotional factors in digital literacy remains unexplored in nursing students.

OBJECTIVE

This study aimed to explore the digital literacy level and determine the predictive role of technical, cognitive, and socio-emotional factors in digital literacy among nursing students in Turkey using a structural equation modeling (SEM)-based approach.

DESIGN

A web-based, predictive, cross-sectional study.

SETTINGS

This study was conducted among first-, second-, third- and fourth-year students in a nursing faculty located in the capital of Turkey in the academic year 2021-2022.

PARTICIPANTS

Overall, 210 nursing students were recruited for this study.

METHODS

The use of a digital literacy model guided data collection. Data were collected between 8 and 28 June 2022 using online Google Forms. The data were analyzed using descriptive statistics and SEM.

RESULTS

Nursing students' digital literacy mean score was 67.29 (13.60). Internet self-efficacy (β = 0.31, p < 0.001), online information search strategies (β = 0.20, p = 0.003), and online privacy concerns (β = 0.14, p = 0.024) were positive predictors, whereas social media use (β = -0.13, p = 0.032) was a negative predictor of digital literacy. Among these variables, Internet self-efficacy had the most significant influence on the digital literacy level. The four variables contributed to 22 % of variance in the digital literacy level.

CONCLUSIONS

This study shows nursing students' digital literacy level is above average. Our findings suggest that technical, cognitive, and socio-emotional factors influence digital literacy.

The mediating effect of financial development on CO2 emissions: An empirical study based on provincial panel data in China

Global climate change has become the greatest threat to humanity, and China is developing policies among various industries to peak CO2 emissions as soon as possible and expects the reduction of CO2 emissions through financial development. Based on the panel data of 30 provinces in China from 2000 to 2017, this paper uses fixed effect model and mediating effect model to explore the mechanism and effective pathway of financial development on CO2 emissions per capita among different regions in China. Empirical results consistently indicate that financial development has the significantly positive effect on CO2 emissions per capita, but the impact is inverted U-shaped. It means that only when the financial development in China gradually increased to 4.21 can achieve the goal of reducing CO2 emissions per capita. These results provide new explanatory ideas for the inconsistent direction of the impact of financial development on carbon emissions in existing studies. Then, the technological innovation and industrial structure are intermediaries for financial development to reduce CO2 emissions per capita, while the economic scale is the opposite. And it illustrates not only theoretical but also empirical results on the mediating pathways of financial development driven CO2 emission reduction. Under the theory of "natural resource curse", in regions with high fossil energy dependence, the mediating effect of the economic scale is greater than that in regions with low fossil energy dependence. But the mediating effects of technological innovation and industrial structure from financial development on CO2 emissions per capita are all negative and more powerful than that in regions with low fossil energy dependence. This provides an important practical basis for the development of differentiated carbon reduction policies through finance in different fossil energy dependent regions.

The effect of agricultural subsidies on chemical fertilizer use: Evidence from a new policy in China

This study uses a nationally representative rural household survey from China, the difference-in-difference, three-step approach, and Seemingly Unrelated Regression methods to assess the impacts of China's new agricultural subsidy on chemical fertilizer use, heterogeneity effect, and mechanism. The results show that, first, the new agriculture subsidy reduces the use of chemical fertilizer by about 7.2 percent. A series of robustness tests confirm the finding. Second, the heterogeneity analysis shows that the subsidy's negative impact on fertilizer use is substantially greater among younger farmers than among older farmers. The negative effect also is significantly more in the main grain-producing areas than in non-grain-producing regions in China. Third, the mediating effect analysis shows that farmland scale mediates 8.3 percent of fertilizer use, and the adoption of agricultural machinery mediates 48.6 percent of fertilizer use. Our findings underscore the positive role that reforming the agrarian subsidy policy plays in sustainable development.

Dissecting the mediating and moderating effects of depression on the associations between traits and coronary artery disease: A two-step Mendelian randomization and phenome-wide interaction study

Background

Depression is often present concurrently with coronary artery disease (CAD), a disease with which it shares many risk factors. However, the manner in which depression mediates and moderates the association between traits (including biomarkers, anthropometric indicators, lifestyle behaviors, etc.) and CAD is largely unknown.

Methods

In our causal mediation analyses using two-step Mendelian randomization (MR), univariable MR was first used to investigate the causal effects of 108 traits on liability to depression and CAD. The traits with significant causal effects on both depression and CAD, but not causally modulated by depression, were selected for the second-step analyses. Multivariable MR was used to estimate the direct effects (independent of liability to depression) of these traits on CAD, and the indirect effects (mediated via liability to depression) were calculated. To investigate the moderating effect of depression on the association between 364 traits and CAD, a cross-sectional phenome-wide interaction study (PheWIS) was conducted in a study population from UK Biobank (UKBB) (N=275,257). Additionally, if the relationship between traits and CAD was moderated by both phenotypic and genetically predicted depression at a suggestive level of significance (Pinteraction≤0.05) in the PheWIS, the results were further verified by a cohort study using Cox proportional hazards regression.

Results

Univariable MR indicated that 10 of 108 traits under investigation were significantly associated with both depression and CAD, which showed a similar direct effect compared to the total effect for most traits. However, the traits "drive faster than speed limit" and "past tobacco smoking" were both exceptions, with the proportions mediated by depression at 24.6% and 7.2%, respectively. In the moderation analyses, suggestive evidence of several traits was found for moderating effects of phenotypic depression or susceptibility to depression, as estimated by polygenic risk score, including chest pain when hurrying, reason of smoking quitting and weight change. Consistent results were observed in survival analyses and Cox regression.

Conclusion

The independent role of traits in CAD pathogenesis regardless of depression was highlighted in our mediation analyses, and the moderating effects of depression observed in our study may be helpful for CAD risk stratification and optimized allocation of scarce medical resources.

Research on the impact of green finance on China's carbon neutralization capacity

At present, the life and production of our society are still accompanied by high pollution emissions. The proposal of the "double carbon" goal puts forward clearer requirements for China's energy conservation and emission reduction process. To cope with stricter green development requirements, green finance came into being, contributing a new path to the realization of the "double carbon" goal. This paper is based on the panel data of 30 provinces and cities in China (except Tibet, Hong Kong, Macao, and Taiwan) from 2011 to 2020, using the fixed effect model, threshold model, mediator model, and SDM model to study the impact of green finance on carbon neutralization capacity and its impact path based on reasonable measurement of regional green finance development level and carbon neutralization capacity. The study found that due to the existence of the "green paradox" and "forced emission reduction", China's green finance has a significant positive U-shaped impact path on carbon neutralization capacity; at the same time, informal regulation has a significant single-threshold effect in this path. When informal regulation crosses 0.47, the impact of green finance on carbon neutralization capacity will change from negative to positive, overcoming the impact of the "green paradox"; there is a nonlinear mediating effect of marketization level and technological innovation in the path of green finance affecting carbon neutralization capacity. In addition, green finance not only affects local carbon neutralization capacity but also has a positive spillover effect on neighboring regions.

Research on the spatial spillover effect of China's carbon emission trading on total-factor carbon emission efficiency of the power industry

Improving the carbon emission efficiency in the power industry is a crucial step to achieve China's "double carbon" goal. Carbon emission trading (CET) is an important tool for carbon emission reduction in the power industry. This paper collects data on the power industry of 30 provinces in China from 2005 to 2020 and applies an undesirable super-efficiency epsilon-based measure (EBM) model to measure the total-factor carbon emission efficiency of the power industry (CEEP). A spatial difference-in-differences (SDID) model is constructed to analyze the spatial spillover effects of China's CET on CEEP. Then, a spatial mediating effect model is employed to explore the influence mechanism of CET. The results show that (1) during the sample period, CEEP shows a trend of fluctuating growth, and the overall level of CEEP is still relatively low; (2) CET has a significant promotion effect on CEEP, resulting in an average increase of 6.02% in the efficiency value of the pilot areas; (3) the spatial spillover effect test proves that CET not only improves the CEEP in the pilot areas, but also promotes the improvement of CEEP in the adjacent areas; and (4) the influence mechanism test shows that CET can improve CEEP by reducing energy intensity, promoting technological progress, and upgrading industrial structure. This study provides a new perspective for the measurement of CEEP and expands the research on the emission reduction effect of CET in the power industry. Finally, based on the research results, this study proposes targeted suggestions to provide reference for the government to formulate emission reduction policies.

Influence of resilience on depression among nurses in clean operating departments: The mediating effect of life satisfaction

BACKGROUND

A clean operating room is an important part of surgical and critical treatment in hospitals. The workload is substantial, the pace is rapid, and the working environment is intense; therefore, nurses who work in clean operating rooms are constantly challenged, which can lead to anxiety, depression, and other mental health issues. Life satisfaction and resilience are important factors that ensure mental health. Therefore, exploring the mediating role of life satisfaction in the influence of resilience on depression among nurses in clean operating rooms can help improve nursing services and teamwork.

AIM

To explore the mediating effect of satisfaction on the influence of resilience on depression among nurses in a clean operating department.

METHODS

From April to November 2022, 196 nurses from the Department of Clean Operating at Harbin Medical University Cancer Hospital participated in this study. Participants were selected using convenience sampling. Participants' gender, age, marital status, position, length of service, personal monthly income, daily working hours, employment status, and professional title were collected, and the Connor-Davidson resilience scale, satisfaction with life scale, and self-rating depression scale were used to evaluate resilience, life satisfaction, and depression. The researchers conducted professional training in advance, introduced the research methods to the participants before the investigation, and explained the study's significance and purpose. Surveys were distributed and collected on-site. Each questionnaire took 30 min to complete.

RESULTS

The average scores for life satisfaction, resilience, and depression were 3.13 (± 0.28), 4.09 (± 0.78), and 56.21 (± 8.70), respectively. The correlation between resilience and depression was negative (r = -0.829, P < 0.01). Life satisfaction was positively related to resilience (r = 0.855, P < 0.01) and negatively related to depression (r = -0.778, P < 0.01). The relationship between resilience and depression was partially mediated by life satisfaction. The value of the mediating effect was -6.853 (26.68% of the total effect).

CONCLUSION

Life satisfaction partially mediates the link between resilience and depression among nurses in clean operating departments.

Mediating effect of physical sub-health in the association of sugar-sweetened beverages consumption with depressive symptoms in Chinese college students: A structural equation model

BACKGROUND

Although previous findings with small samples indicated that sugar-sweetened beverages (SSB) consumption was associated with depressive symptoms in adolescents, the mediating effect of physical sub-health in the association is unknown.

METHODS

A survey was conducted among freshmen from 11 provinces in China. A food frequency questionnaire was used to collect dietary behavior, and patient health questionnaire-9 items was used to assess depressive symptoms. A generalized linear model was used to analyze the association between SSB consumption, physical sub-health and depressive symptoms. The structural equation model was used to analyze the mediating effect of physical sub-health.

RESULTS

Of the 31,856 participants, 36.5 % had positive depressive symptoms. After adjusting for variables, carbonate beverages (β = 0.11; 95%CI: 0.07-0.15; P = 0.000) and milk tea (β = 0.07; 95%CI: 0.01-0.13; P = 0.021) consumption was associated with depressive symptoms in boys. Carbonate beverages (β = 0.09; 95%CI: 0.05-0.13; P = 0.000), tea beverages (β = 0.09; 95%CI: 0.04-0.13; P = 0.000), and milk tea (β = 0.08; 95%CI: 0.04-0.11; P = 0.000) consumption was associated with depressive symptoms in girls. The mediating effect of physical sub-health accounted for 81.3 % of the total effect in the mediating model of SSB associated with depressive symptoms.

LIMITATIONS

Retrospective survey has certain information bias. Association observed in the cross-sectional study is uncertain.

CONCLUSIONS

The present study suggests that the consumption of SSB associated with depressive symptoms in Chinese college students, and physical sub-health plays a complete mediating role in the association.

The effect of perceived social support on postpartum stress: the mediating roles of marital satisfaction and maternal postnatal attachment

BACKGROUND

Multiple factors may be responsible for the development of postpartum stress, including perceived social support, marital satisfaction, and maternal postnatal attachment. However, the underlying mediation mechanisms remain unclear. This study examined the complex relationships between perceived social support and postpartum stress among Chinese women.

METHODS

A convenience sample comprising 406 postpartum women was recruited from six hospitals in Nantong, Jiangsu Province, China. The participants completed general survey questionnaires and were evaluated using the Maternal Postpartum Stress Scale, the Perceived Social Support Scale, the Maternal Postnatal Attachment Scale, and the Marital Satisfaction Scale. Furthermore, we evaluated the relationship between postpartum stress and the various influencing factors by performing a multiple linear regression analysis. The potential mediating roles of marital satisfaction and maternal and infant attachment in the association between perceived social support and postpartum stress were explored by performing a mediation analysis.

RESULTS

According to the multivariate regression analysis, perceived social support, marital satisfaction, and maternal postnatal attachment contributed to postpartum stress levels (P < 0.05). The mediation analysis revealed that marital satisfaction and maternal postnatal attachment played parallel mediating roles in the association between perceived social support and postpartum stress, and the mediating effect of marital satisfaction was - 0.1125 (95% confidence interval [CI]: -0.1784 to -0.0520), accounting for 33.20% of the total effect, and the mediating effect of maternal postnatal attachment was - 0.0847 (95% CI: -0.1304 to -0.0438), accounting for 25.00% of the total effect.

CONCLUSION

Our study revealed that perceived social support could influence postpartum stress not only through direct effect (41.80% of the total effect), but also through the indirect effect (mediation effect) of marital satisfaction and maternal postnatal attachment (58.20% of the total effect), suggesting that improving postpartum women's social support, enhancing maternal and infant attachment, and improving their marital satisfaction could help lower postpartum stress.

A Low Degree of Physical Exercise Adherence in College Students: Analyzing the Impact of Interpersonal Skills on Exercise Adherence in College Students

Physical exercise adherence (PEA) is multifaceted and significantly influenced by elements such as physical prowess, personality traits, psychosocial traits, and demographics. At present, there are problems such as the low degree of PEA in college students. Studies have shown that exercise adherence (EA) can be improved by adjusting psychological factors. Social abilities are one of the important manifestations of mental health, so this study aims to explore the intrinsic influence mechanism of social abilities on college students' PEA. Shanghai Sports University consistently ranks first among Chinese institutions that specialize in sports in the list of the best Chinese institutions. Therefore, this study decided to survey Shanghai University students. Valid data were collected from 1278 students from 6 universities in Shanghai using a questionnaire survey method. The ordinary least square (OLS) regression analysis technique was utilized in the study. The study has shown that (1) boys have stronger social abilities than girls; (2) the exercise attitude and exercise persistence of junior students are better than those of freshmen and sophomores; (3) social abilities, emotion regulation strategies, exercise needs satisfaction, exercise attitude, and EA were significantly positively associated with each other. Emotion regulation strategies and exercise attitude had a negative predictive effect on PEA, and exercise needs satisfaction and social abilities had a significant predictive effect on exercise adherence. (4) Exercise needs satisfaction and exercise attitude were used as mediating variables to regulate the influence of college students' social abilities on EA.

Relationship of family function and pre-hospital delay among Chinese patients with recurrent ischaemic stroke and the mediation effect of stigma

AIMS

Pre-hospital delay refers to the time span from the onset of symptoms to arrival at a hospital ≥ 3 h and is the main limitation of stroke reperfusion therapies. Family factors and stroke-related stigma may influence pre-hospital delay. However, few studies have confirmed the influence of stigma on pre-hospital delay or explored the relationships between family function, stigma, and pre-hospital delay among patients with recurrent stroke. This study aimed to explore the relationship between family function and pre-hospital delay among patients with recurrent stroke and examine the mediation role of stigma in this relationship.

METHODS AND RESULTS

A cross-sectional study was performed at the neurology departments of two hospitals in Guangzhou, China between July 2021 and April 2022. A total of 115 patients with recurrent stroke completed questionnaires and were included in the analysis. Data were collected using the Short Form Family Assessment Device, the Stroke Stigma Scale, and the Stroke Knowledge Questionnaire. Spearman's correlation and a structural equation model were used for data analysis. Family function directly influenced pre-hospital delay [β=0.27, P = 0.033, 95%CI = (0.02-0.51)] and indirectly influenced pre-hospital delay [β=0.17, P = 0.038, 95%CI = (0.02-0.34)] through stigma. Moreover, stigma partially mediated the effect of family function on pre-hospital delay.

CONCLUSION

Family function and stigma directly and indirectly influenced pre-hospital delay among patients with recurrent stroke. Future health education and interventions need to focus on strengthening and improving emotional support from family members to improve family function and reduce stigma, thereby reducing pre-hospital delay among patients with recurrent stroke.

The Dunning-Kruger effect: subjective health perceptions on smoking behavior among older Chinese adults

BACKGROUND

The intrinsic damage and external hazards of smoking are major risk factors for poorer health and are recognized as a global health issue of concern in geriatric health. This study aims to assess the Dunning-Kruger effect through the influence of subjective health perceptions on smoking behavior in older adults.

METHODS

This study used data from the 2018 Chinese Longitudinal Healthy Longevity Survey (N = 9,683) provided by the Center for Healthy Aging and Development Studies at Peking University. A binary logistic model was used to examine whether the Dunning-Kruger effect affects smoking behavior in older adults, and a linear probability model was used as a commentary baseline model for logistic regression to prevent measurement bias. In addition, a mediating analysis was used to examine the mechanisms through which the Dunning-Kruger effect occurs.

RESULTS

Older adults often overestimated their current health status and underestimated the health risks of smoking, causing the Dunning-Kruger effect to arise from their inadequate self-perceived health (i.e., older adults are more likely to smoke when they have better self-rated health or when hypertension, cardiopathy, stroke, and diabetes have little or no impact on their daily lives). These observations can be explained by the older adults' subjective health perceptions arising from their ingenuous understanding of their health, which indirectly influences their smoking behavior to some extent.

CONCLUSION

Older adults' self-perceived health was associated with smoking behavior. Public health institutions should improve older adults' health perceptions so that they objectively understand their own health status.

Daily stress, and mental health of professional degree graduate students in Chinese traditional medicine universities: the mediating role of learning career adaptation

BACKGROUND

With the expansion of professional degree graduate students' enrollment in China education, the mental health of these professional degree graduate students in medical-related majors who are under pressure of study, scientific research, clinical practice, and employment should not be ignored. What is the mental health level of these graduate students under the effect of learning career adaptation (internal resources) in the face of daily stress (external factors)? The purpose of this study is to discuss the relationship between these variables, and the mediating role of learning career adaptation of professional degree graduate students in traditional Chinese medicine colleges, and universities, to provide a theoretical basis for improving the learning career adaptation of students, and improving the level of mental health.

METHODS

A cross-sectional survey was conducted among 1593 professional degree graduate students majoring in clinical medicine, traditional Chinese medicine, and nursing in five traditional Chinese medicine universities. Finally, 660 questionnaires were returned, with a recovery rate of 41.43%. The scores of daily stress, learning career adaptation, and mental health were measured by Daily Stressors Scale for graduate students, graduate-students learning career adaptation scale, and General Mental Health Questionnaire (GHQ-20). Descriptive statistics were used to analyze the status quo of daily stress, learning career adaptation, and mental health. Pearson correlation analysis were used to analyze the relationship between them. we undertake analyses using structural equation modeling to construct the latent variable path model of daily stress, learning career adaptation on mental health. The significance level of the mediating effect was tested by the non-parametric percentile bootstrap method.

RESULTS

The scores of mental health, daily stress, and learning career adaptation were 50.56 ± 10.80, 35.12 ± 19.55, and 67.13 ± 7.48 respectively. Daily stress was negatively correlated with the three dimensions of learning career adaptation: career confidence, focus on his career, and career control (P < 0.01). Daily stress was positively correlated with depression and anxiety (P < 0.01). Self-affirmation, depression, and anxiety were negatively correlated with career confidence, focus on his career, and career control (P < 0.05). Learning career adaptation plays a partial mediating role between daily stress, and mental health (p < 0.001), with an intermediate effect value of 0.127, representing 28.54% of the total effect.

CONCLUSIONS

Mental health, learning career adaption of medical-related professional degree graduate students in traditional Chinese medical universities were at a moderate degree, and an upper-middle level respectively, while daily stress is to a lesser extent. Learning career adaptation mediates the relationship between daily stress, and mental health partially. To some extent, it can buffer the impact of daily stress on mental health, especially anxiety. The educational administrator could take various measures to improve the mental health of professional degree graduate students. It can also enhance their learning career adaptation from the perspective of individuals, and organizations to improve their mental health.

The impact of green finance on industrial pollution emissions: Empirical evidence from economic and environmental perspectives

Green finance can make full use of financial instruments to control industrial pollution emissions, thus becoming an important initiative to balance ecological environment and economic growth. Based on panel data from 30 Chinese provinces, this study adopts a fixed effect model to test the impact of green finance on industrial pollution emissions, followed by the application of instrumental variables, a GMM dynamic panel, and exogenous shock tests to ensure the robustness of the benchmark results. The results indicate that green finance is capable of controlling the total amount and intensity of industrial pollution emissions, that is to say, to realize the "double control" of industrial pollution emissions, taking into account economic growth and environmental protection. The mediating effect model concludes that green finance can influence industrial pollution emissions through green technology innovation and industrial structure upgrading, but the impact of these two mechanisms on the total amount and intensity of industrial pollution emissions has its own focus. Heterogeneity analysis shows that green finance is more significant in reducing the intensity of industrial pollution emissions in resource-general areas and areas with high levels of information technology, and the shift from controlling the total amount indicator to the intensity indicator implies that green finance is more effective in promoting economic growth while protecting the environment. Our empirical findings offer important policy implications for reducing industrial pollution emissions from both economic and environmental perspectives.

Relationship among subjective exercise experience, exercise behavior, and trait anxiety in adolescents

OBJECTIVE

To investigate the influence of subjective exercise experience on adolescent trait anxiety and to reveal the mediating effect of exercise behavior.

METHODS

Using the Subjective Exercise Experience Scale (SEES), Physical Exercise Rating Scale (PARS-3), and Trait Anxiety Inventory (T-AI), a questionnaire survey was conducted among 500 adolescents in Southwest China, and the SPSS21.0 and AMOS21.0 statistical analysis software was used to statistics and analysis on the questionnaires.

RESULTS

1) Among adolescents, the exercise behavior of boys was significantly higher than that of girls (p < 0.05), and the subjective exercise experience of students aged 9 to 12 was significantly higher than that of students aged 12 to 15 (p < 0.05). 2) The subjective exercise experience could directly and positively predict exercise behavior (β = 0.45, p < 0.001) and negatively predict trait anxiety (β = -0.26, p < 0.05), and exercise behavior could directly and negatively predict trait anxiety (β = -0.32, p < 0.01). 3) The exercise behavior played a partial mediating effect between subjective exercise experience and trait anxiety (the mediation effect was -0.14). Among them, compared with low- and high-exercise amounts, the exercise behavior of moderate exercise amounts had the strongest mediating effect between subjective exercise experience and trait anxiety.

CONCLUSION

The good subjective exercise experience not only has direct benefits for improving trait anxiety in adolescents but also helps to improve their exercise behavior, enrich daily physical exercise activities, and indirectly promote the reduction of trait anxiety.

Relationship between illness perception and family resilience in gynecologic cancer patients: the mediating role of couple illness communication

OBJECTIVE

To analyze the current family resilience levels of Chinese patients with gynecologic cancer and explore the mediating role of couple illness communication between illness perception and family resilience to facilitate patient adaptation to cancer.

METHODS

A total of 310 patients with gynecologic cancer were selected from the gynecology ward of a tertiary care hospital in Jinan, Shandong Province, China. All participants provided their demographic and clinical information and completed the Brief Illness Perception Questionnaire (BIPQ), Couples' Illness Communication Scale (CICS), and Family Hardiness Index (FHI). The mediating effect of couple illness communication was analyzed using SPSS26.0 and Amos21.0.

RESULTS

The family resilience score of patients with gynecologic cancer was moderate (55.78 ± 8.65). Illness perception was negatively correlated with couple illness communication(p < 0.05) and family resilience(p < 0.01), while couple illness communication was positively correlated with family resilience (p < 0.01). Couple illness communication mediated the relationship between illness perception and family resilience [β = - 0.071; 95% confidence interval: (- 0.127)-(- 0.013)].

CONCLUSIONS

The family resilience of patients with gynecologic cancer must be further improved. Since couple illness communication mediates the relationship between illness perception and family resilience in this population, it is important to improve patients' illness perceptions and couple illness communication to enhance their family resilience.

Risk and protective factors for resilience among adolescents and young adults with beta-thalassemia major

BACKGROUND

Resilience is the ability to overcome adversity in response to a potentially traumatic event. It can relieve people's discomfort and build personal capacity when facing a stressful situation such as beta thalassemia major. Resilience is a complex and multidimensional concept and is influenced by protective and risk factors. Therefore, the aims of the present study were to (1) investigate the relationship between protective (social support and hope) and risk (uncertainty and defensive coping) factors with resilience and (2) examine the mediating role of courageous coping between these protective and risk factors in resilience.

METHODS

This descriptive-analytical study was performed on 312 adolescents and young adults with beta-thalassemia major aged 12-24 years; they were selected using purposeful sampling from two different outpatient thalassemia clinics in the south of Iran. Data were collected in a face-to-face survey using Zimmet Multidimensional Scale of Perceived Social Support, Herth Hope, Stewart Uncertainty in Illness scale, Jalowiec Coping, and Connor-Davidson resilience Scale from April 2022 to November 2022. The collected data were analyzed using descriptive tests, Pearson correlation, and a structural equation model.

RESULTS

According to the main findings of mediation analysis, courageous coping partially mediated the relationship between social support and resilience [(β = 0.042; 95% BC CI (0.003, 0.131)] and fully mediated the relationship between hope and resilience [(β = 0.166; 95% BC CI (0.031, 0.348)]. In other cases, uncertainty and defensive coping had a direct and indirect effect on resilience, respectively.

CONCLUSION

Based on these results, health professionals and healthcare policymakers should consider this mediator in developing programs to improve resilience. Also, the use of courageous coping could modulate the effect of defensive coping on resilience. Therefore, teaching the use of courageous coping can play an important role in improving resilience.

Assessing the effects of organizational support, psychological capital, organizational identification on job performance among nurses: a structural equation modeling approach

BACKGROUND

The job performance of individual employees determines the overall performance of an organization, and organizational support is known as an important resource at the organizational level to enhance job performance. Although nursing scholars have confirmed the crucial role of organizational support in enhancing job performance, there are no studies on whether psychological capital and organizational identification mediate the association between organizational support and job performance. The purpose of this study is to investigate the influence of organizational support, psychological capital, and organizational identification on nurses' job performance.

METHODS

A cross-sectional survey was conducted among 455 nurses from 21 public hospitals in China. Instruments were perceived organizational support scale, task performance scale, contextual performance scale, Nurse Psychological Capital Questionnaire, and Organizational Identification Questionnaire. Survey data were analyzed using SPSS and AMOS, and hypotheses were tested using path model analysis.

RESULTS

Nurses' perceived organizational support, psychological capital, organizational identification, and task/contextual performance were positively correlated in every two variables. Psychological capital played an important mediating role in perceived organizational support and task/contextual performance, as well as organizational identification. The multi-mediating effect of psychological capital and organizational identification on the relationship between organizational support and task/contextual performance were 0.14 and 0.25, respectively.

CONCLUSIONS

There was a positive correlation between organizational support and job performance among nurses. Psychological support, organizational identification and contextual performance played a chain mediation role in the relationship between organizational support on task performance in nurses. Nursing managers should pay more attention to enhancing nurses' psychological capital and organizational identification through effective interventions to improve nurses' job performance.

Neuroticism mediates the association between childhood abuse and the well-being of community dwelling adult volunteers

BACKGROUND

Previous studies reported that the experience of maltreatment in childhood reduces subjective well-being in adulthood and that neuroticism is negatively associated with subjective well-being. However, the interrelationship between childhood maltreatment, adult life events, neuroticism, and subjective well-being has not been analyzed to date.

METHODS

A total of 404 adult volunteers provided responses to the following questionnaires: 1) Childhood Abuse and Trauma Scale, 2) Life Experiences Survey, 3) Neuroticism Subscale of the Shortened Eysenck Personality Questionnaire-Revised, and 4) Subjective Well-Being Inventory. The path model was used to analyze possible interrelationships among these parameters.

RESULTS

The effect of childhood abuse on subjective well-being was indirect and was mediated by neuroticism. The effect of neuroticism on the negative, but not positive, change score on the Life Experiences Survey was significant. The indirect effect of neuroticism on subjective well-being was not significant via either negative or positive change scores.

CONCLUSIONS

This study demonstrated that age, subjective social status, neuroticism, and negative and positive life events were significantly associated with subjective well-being. Furthermore, using path analysis, we demonstrated the mediating role of neuroticism in the indirect effect of childhood abuse on subjective well-being.

Adiposity and lipid metabolism indicators mediate the adverse effect of glucose metabolism indicators on oogenesis and embryogenesis in PCOS women undergoing IVF/ICSI cycles

BACKGROUND

Polycystic ovary syndrome (PCOS) women have high incidences of dyslipidemia, obesity, impaired glucose tolerance (IGT), diabetes, and insulin resistance (IR) and are fragile to female infertility. Obesity and dyslipidemia may be the intermediate biological mechanism for the associations between glucose metabolism dysfunction and abnormal oogenesis and embryogenesis.

METHODS

This retrospective cohort study was performed at a university-affiliated reproductive center. A total of 917 PCOS women aged between 20 and 45 undergoing their first IVF/ICSI embryo transfer cycles from January 2018 to December 2020 were involved. Associations between glucose metabolism indicators, adiposity and lipid metabolism indicators, and IVF/ICSI outcomes were explored using multivariable generalized linear models. Mediation analyses were further performed to examine the potential mediation role of adiposity and lipid metabolism indicators.

RESULTS

Significant dose-dependent relationships were found between glucose metabolism indicators and IVF/ICSI early reproductive outcomes and between glucose metabolism indicators and adiposity and lipid metabolism indicators (all P < 0.05). Also, we found significant dose-dependent relationships between adiposity and lipid metabolism indicators and IVF/ICSI early reproductive outcomes (all P < 0.05). The mediation analysis indicated that elevated FPG, 2hPG, FPI, 2hPI, HbA1c, and HOMA2-IR were significantly associated with decreased retrieved oocyte count, MII oocyte count, normally fertilized zygote count, normally cleaved embryo count, high-quality embryo count, or blastocyst formation count after controlling for adiposity and lipid metabolism indicators. Serum TG mediated 6.0-31.0% of the associations; serum TC mediated 6.1-10.8% of the associations; serum HDL-C mediated 9.4-43.6% of the associations; serum LDL-C mediated 4.2-18.2% of the associations; and BMI mediated 26.7-97.7% of the associations.

CONCLUSIONS

Adiposity and lipid metabolism indicators (i.e., serum TG, serum TC, serum HDL-C, serum LDL-C, and BMI) are significant mediators of the effect of glucose metabolism indicators on IVF/ICSI early reproductive outcomes in PCOS women, indicating the importance of preconception glucose and lipid management and the dynamic equilibrium of glucose and lipid metabolism in PCOS women.

Can financial development improve environmental quality? New findings from spatial measures of Chinese urban panel data

China's economy has achieved remarkable success, while it has also paid a high environmental cost. Environmental pollution not only causes great economic losses, but also severely restricts the development of society. Both theory and practice demonstrate that financial development plays a significant role in environmental governance, but the internal mechanism of its impacts has remained to be explored. It is vital to investigate the influence mechanism of financial development on the environmental quality in order to accomplish sustainable economic development through finance and enhance environmental quality concurrently. This paper, using mediating model, spatial Durbin and spatial error model, constructs a theoretical framework financial development on environmental quality from two dimensions, i.e., Financial Interrelations Ratio (FIR) and Financial Efficiency (FE), based on panel data of 234 cities in China from 2010 to 2019. And the results are as follows: (1) the improvement of Financial Interrelations Ratio (FIR) and Financial Efficiency (FE) had not yet reached the level of environmental pollution improvement; (2) in terms of mechanism, the rise of the level of financial development promoted economic growth, but inhibited the optimization of industrial structure, which increased industrial pollution emissions and deteriorates environmental quality; (3) urban environment had significant spatial dependence; (4) the impact of financial development on environmental quality in eastern region has been transformed into an improvement effect, while it still shows a deteriorating effect in central and western regions. Some policy recommendations related to the use of financial development to improve environmental quality are proposed at last, which will help to promote ecological protection and high quality synergistic economic development in China.

[The mediating effect of resilience on anxiety and subjective well-being in occupational population]

Objective: To explore the current situation of anxiety, subjective well-being in occupational population and the mediating effect of resilience. Methods: From March 24th to 26th, 2020, a cross-sectional survey was conducted among occupational population aged ≥18 years old using online questionnaires. A total of 2134 valid questionnaires were obtained, with respondents from 30 provinces, autonomous regions, and municipalities directly under the Central Government. Their general demographic data, subjective well-being, anxiety, and resilience were collected. Pearson χ(2) test and Spearson correlation analysis were used for data analysis, and structural equation model was used to explore the mediating effect of resilience on anxiety and subjective well-being. Results: The age of the respondents ranged from 18 to 60 years old, with an average age of (31.19±7.09) years old, including 1075 (50.4%) women and 1059 (49.6%) men. The positive rates of low subjective well-being and anxiety were 46.5% (992/2134) and 28.4% (607/2134), respectively. Anxiety scores were significantly negatively correlated with subjective well-being scores and resilience scores (r(s)=-0.52, -0.41, P<0.05), while resilience was significantly positively correlated with subjective well-being (r(s)=0.32, P<0.05). Structural equation models showed that anxiety had a negative predictive effect on subjective well-being, while resilience not only had a positive predictive effect on subjective well-being, but also played a mediating role between anxiety and subjective well-being, with a mediating effect of 9.9%. Conclusion: The situation of anxiety and well-being in the occupational population is still not optimistic, and resilience has a mediating effect between anxiety and subjective well-being.

Relationship between depression, smartphone addiction, and sleep among Chinese engineering students during the COVID-19 pandemic

BACKGROUND

Existing research has demonstrated that depression is positively related to smartphone addiction, but the role of sleep has not been discussed thoroughly, especially among engineering undergraduates affected by the coronavirus disease 2019 pandemic.

AIM

To evaluate sleep as a mediator of the association between smartphone addiction and depression among engineering undergraduates.

METHODS

Using a multistage stratified random sampling method, a cross-sectional survey was conducted among 692 engineering undergraduates from a top engineering university in China, and data were collected by self-reported electronic questionnaires. The data included demographic characteristics, such as age, gender, the Smartphone Addiction Scale-Short Version (SAS-SV), the 9-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index. Pearson correlation and multiple linear regression analyses were used to examine the association between smartphone addiction and depression, while structural equation models were established to evaluate the possible mediating role of sleep.

RESULTS

Based on the cutoffs of the SAS-SV, the rate of smartphone addiction was 63.58 percent, with 56.21 percent for women and 65.68 percent for men, among 692 engineering students. The prevalence of depression among students was 14.16 percent, with 17.65 percent for women, and 13.18 percent for men. Smartphone addiction was positively correlated with depression, and sleep played a significant mediating effect between the two, accounting for 42.22 percent of the total effect. In addition, sleep latency, sleep disturbances, and daytime dysfunction significantly mediated the relationship between depression and smartphone addiction. The mediating effect of sleep latency was 0.014 [P < 0.01; 95% confidence interval (CI): 0.006-0.027], the mediating effect of sleep disturbances was 0.022 (P < 0.01; 95%CI: 0.011-0.040), and the mediating effect of daytime dysfunction was 0.040 (P < 0.01; 95%CI: 0.024-0.059). The influence of sleep latency, sleep disturbances, and daytime dysfunction accounted for 18.42%, 28.95%, and 52.63% of the total mediating effect, respectively.

CONCLUSION

The results of the study suggest that reducing excessive smartphone use and improving sleep quality can help alleviate depression.

The mediating role of telomere length in multi-pollutant exposure associated with metabolic syndrome in adults

Metabolic syndrome is a chronic and complex disease characterized by environmental and genetic factors. However, the underlying mechanisms remain unclear. This study assessed the relationship between exposure to a mixture of environmental chemicals and metabolic syndrome (MetS) and further examined whether telomere length (TL) moderated these relationships. A total of 1265 adults aged > 20 years participated in the study. Data on multiple pollutants (polycyclic aromatic hydrocarbons, phthalates, and metals), MetS, leukocyte telomere length (LTL), and confounders were provided in the 2001-2002 National Health and Nutrition Examination Survey. The correlations between multi-pollutant exposure, TL, and MetS in the males and females were separately assessed using principal component analysis (PCA), logistic and extended linear regression models, Bayesian kernel machine regression (BKMR), and mediation analysis. Four factors were generated in PCA that accounted for 76.2% and 77.5% of the total environmental pollutants in males and females, respectively. The highest quantiles of PC2 and PC4 were associated with the risk of TL shortening (P < 0.05). We observed that the relationship between PC2, PC4, and MetS risk was significant in the participants with median TL levels (P for trend = 0.04 for PC2, and P for trend = 0.01 for PC4). Furthermore, mediation analysis revealed that TL could explain 26.1% and 17.1% of the effects of PC2 and PC4 associated with MetS in males, respectively. The results of BKMR model revealed that these associations were mainly driven by 1-PYE (cPIP = 0.65) and Cd (cPIP = 0.29) in PC2. Meanwhile, TL could explain 17.7% of the mediation effects of PC2 associated with MetS in the females. However, the relationships between pollutants and MetS were sparse and inconsistent in the females. Our findings suggest that the effects of the risk of MetS associated with mixed exposure to multiple pollutants are mediated by TL, and this mediating effect in the males is more pronounced than that in the females.

Education, Social Engagement, and Cognitive Function: A Cross-Lagged Panel Analysis

OBJECTIVES

Although education and social engagement are considered cognitive reserves, the pathway of both reserves on cognitive function have been rarely studied. This study aimed to examine the underlying mechanism between education, social engagement, and cognitive function.

METHODS

This study used two-wave data (2010 and 2014) from Health and Retirement Study (HRS) in the United States (N = 3201). Education was measured by years of schooling. Social engagement was evaluated by 20 items including volunteering, physical activities, social activities, and cognitive activities. Cognitive function was assessed by a modified Telephone Interview for Cognitive Status (TICS). A cross-lagged panel model was fitted to test the mediating mechanism between education, social engagement, and cognitive function.

RESULTS

Controlling for covariates, higher education in early life was associated with better cognitive function in old age (b = 0.211, 95% CI = [0.163, 0.259], p<0.01). Late-life social engagement partially mediated the association between education and cognitive function (indirect effect = 0.021, 95% CI = [0.010, 0.033], p<0.01). The indirect path between education and social engagement via cognition also existed (b = 0.009, 95% CI = [0.005, 0.012], p<0.001).

DISCUSSION

Education in earlier life stage may exert a lifelong effect on cognitive function as well as an indirect effect via enhancing late-life cognitive reserve such as social engagement. The cross-lagged effect of social engagement on cognitive function is significant and vice versa. Future research may explore other cognitive reserves over the life course and its underlying mechanism to achieve healthy cognitive aging.

The promotion of pooling level of basic medical insurance and participants' health: impact effects and mediating mechanisms

BACKGROUND

Enhancing the pooling of basic medical insurance plays a vital role in strengthening the resilience to risk and co-payment capacity of medical insurance funds. In China, there is a concerted effort to shift from municipal to provincial pooling of medical insurance. While existing research suggests that provincial pooling of basic health insurance affects the health of participants, the findings are not yet consistent, and there is limited research on the specific pathways of impact between the two. Therefore, this study aims to explore the influence of provincial pooling of basic medical insurance on participants' health and analyze the mediating role of medical cost burden and medical service utilization.

METHODS

Using data from the 2012-2018 China Labor Dynamics Survey (CLDS), this study focuses on a sample of urban workers enrolled in basic medical insurance. After excluding samples with missing information, a total of 5,684 participants were included in the analysis. The effects of the provincial pooling policy of basic medical insurance on participants' medical cost burden, medical service utilization, and health were analyzed using double difference modeling. Furthermore, structural equation modeling was employed to explore the mediating paths between provincial pooling and health.

RESULTS

The findings reveal that provincial pooling of basic medical insurance significantly impacts participants' medical cost burden, medical service utilization, and health. Specifically, provincial pooling helps reduce the participants' medical cost burden (β = -0.1205; P < 0.001), improves the level of medical institutions visited (β = 1.7962; P < 0.001), and promotes health improvement (β = 1.8370; P < 0.001). The mediating effect analysis demonstrates that the direct effect of provincial pooling on health is 1.073 (P < 0.001), with a mediating effect of medical cost burden between provincial pooling and health measuring 0.129 (P < 0.001). Heterogeneity analysis indicates that provincial pooling is more effective in reducing the burden of medical costs for low-income (β = -0.2273; P < 0.001) and high-age participants (β = -0.2710; P < 0.001), and it also helps increase the burden of medical costs for low-income (β = 4.0875; P < 0.001) and high-age participants (β = 1.9010; P < 0.001) based on provider ranking. Moreover, it is found that provincial pooling is more beneficial in improving the health of high-income (β = 1.7984; P < 0.001) and middle- and high-age enrollees (β = 1.9220; P < 0.001; β = 0.5900; P < 0.001). Further analysis reveals that the provincial unified income and expenditure mode has a more positive effect than the provincial risk adjustment fund mode in reducing the medical expense burden of the insured (-0.2053 < -0.0775), improving the grade of medical institutions (1.8552 > 0.8878), and enhancing the health level (2.8406 > 0.6812).

CONCLUSION

The study concludes that provincial pooling of basic medical insurance has a direct positive impact on participants' health and indirectly promotes health improvement by reducing the burden of medical costs. The effects of provincial pooling on participants' medical cost burden, medical service utilization, and health vary based on income and age. Additionally, the provincial-level unified collection and payment model proves to be more advantageous in optimizing the functioning of health insurance funds through the "law of large numbers" principle.

Threshold effects of population aging on carbon emissions: From the perspective of industrial structure and residential consumption

Population aging and climate change caused by anthropogenic greenhouse gas emissions are two of the major challenges facing contemporary humanity. Based on panel data for 63 countries from 2000 to 2020, this paper empirically identifies and explores the threshold effects of population aging on carbon emissions, and tests in a causal inference framework the mediating effect mechanism of aging on carbon emissions through two pathways: industrial structure and consumption. Results show that generally when the percentage of the elderly population is higher than 14.5 %, carbon emissions related to industrial structure and residential consumption are significantly reduced although the threshold effects differ across countries. Particularly for lower-middle-income countries, the direction of the threshold effect is uncertain, which indicates the less importance of population aging for carbon emissions in these countries.

Mediating effect of endocrine hormones on association between per- and polyfluoroalkyl substances exposure and birth size: Findings from sheyang mini birth cohort study

BACKGROUND

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) has been reported to affect fetus growth, but current results were inconsistent and their mechanism remained unclear.

OBJECTIVES

We aimed to evaluate the associations of prenatal exposure to single and/or multiple PFAS with birth size and to elucidate whether thyroid hormones and reproductive hormones mediate these associations.

METHODS

A total of 1087 mother-newborn pairs from Sheyang Mini Birth Cohort Study were included in the present cross-sectional analysis. 12 PFAS, 5 thyroid hormones and 2 reproductive hormones were measured in cord serum. Multiple linear regression models and Bayesian kernel machine regression (BKMR) models were used to examine the associations of PFAS with either birth size or endocrine hormones. One-at-a-time pairwise mediating effect analysis was applied to estimate the mediating effect of single hormone in the association between individual chemical and birth size. High-dimensional mediation approach including elastic net regularization and Bayesian shrinkage estimation were further performed to reduce exposure dimension and figure out the global mediation effects of joint endocrine hormones.

RESULTS

Perfluorononanoic acid (PFNA) exposure was positively associated to weight for length z score [WLZ, per log10-unit: regression coefficient (β) = 0.26, 95% confidence intervals (CI): 0.04, 0.47] and ponderal index (PI, β = 0.56, 95% CI: 0.09, 1.02), and PFAS mixture results fit by BKMR model showed consistent consequences. High-dimensional mediating analyses revealed that thyroid stimulating hormone (TSH) explained 6.7% of the positive association between PFAS mixtures exposure and PI [Total effect (TE) = 1.499 (0.565, 2.405); Indirect effect (IE) = 0.105 (0.015, 0.231)]. Besides, 7.3% of the PI variance was indirectly explained by 7 endocrine hormones jointly [TE = 0.810 (0.802, 0.819); IE = 0.040 (0.038, 0.041)].

CONCLUSIONS

Prenatal PFAS mixtures exposure, especially PFNA, was positively associated to birth size. Such associations were partly mediated by cord serum TSH.

Mediating effects of core competence between the transition shock and work readiness of newly graduated nurses in cancer hospitals: A cross-sectional study

BACKGROUND

Newly graduated nurses face a dilemma of transitioning from student to clinical nurse roles, resulting in a low level of work readiness. The special professional environment of oncology hospitals requires newly graduated nurses to have specialized and novel theoretical knowledge and nursing skills. Therefore, they are constantly expected to develop better core competence. However, whether the core competence of newly graduated nurses mediates the relationship between transition shock and work readiness has not been investigated.

OBJECTIVE

This study examined the relationship among transition shock, core competence, and work readiness of newly graduated nurses in cancer hospitals.

DESIGN

A descriptive, cross-sectional study design.

SETTING

This study was conducted at a tertiary cancer hospital in Beijing.

PARTICIPATIONS

A convenience sample of 188 newly graduated nurses was studied from July to August 2022.

METHODS

Sociodemographic data and Transition Shock Scale for Newly Graduated Nurses, Work Readiness Scale for Newly Graduated Nurses, and Core Competence Scale scores were collected using the online Questionnaire Star support platform. Pearson correlation and multiple regression analysis were applied using the Statistical Package for the Social Sciences version 24 to test the relationship among transition shock, core competencies, and work readiness. The Analysis of Moment Structures version 24.0 software was used to construct structural equation models. This report followed the Strengthening the Reporting of Observational studies in Epidemiology checklist.

RESULTS

The transition shock of newly graduated nurses was negatively correlated with work readiness and core competence, whereas core competence was positively correlated with work readiness. Core competence partially mediated the effect between transition shock and work readiness, accounting for 19 % of the total effect.

CONCLUSION

Core competence is the mediating variable between transition shock and work readiness of newly graduated nurses in oncology hospitals. During the transition period of newly graduated nurses, clinical nursing managers and teachers should pay attention to cultivating the core competence of newly graduated nurses to improve their work readiness.