Bias-corrected Bootstrap Confidence Intervals Research Articles

The relationship between expressive suppression, therapeutic bond, and treatment outcomes of a positive affect intervention for adults with anxiety and/or depression

ABSTRACT Expressive suppression (ES; reducing emotional expression) is linked with reduced social connectedness in individuals with anxiety or depression. One implication is that people who use ES may have difficulty establishing a bond with their therapist which may impede clinical improvement. We examined this hypothesis in 33 adults with clinically elevated anxiety or depression receiving treatment focused on enhancing positive thoughts, emotions, and behaviors. At baseline, participants rated ES for positive and negative emotions during a standardized conversation task designed to generate connectedness. They also rated measures of early (session 3) perceived therapeutic bond and treatment outcomes (i.e. positive affect and social connectedness). ES of positive (r = -.39, p = .018), but not negative (r = .06, p = .747), emotions was negatively associated with therapeutic bond. Therapeutic bond mediated the relationship between greater ES of positive emotions during affiliation and lower post-treatment positive affect, 95% bias-corrected bootstrap confidence interval [−0.021, −0.000], adjusted for pre-treatment positive affect, as well as lower post-treatment social connectedness [−0.397, −0.015]; however, the indirect effect was not significant when accounting for pre-treatment social connectedness (p > .05). ES of positive emotions may be an important factor in the development of therapeutic bond and therefore treatment outcomes for individuals with anxiety or depression.

Relationship Between Electronic Health Literacy and Self-Management in People With Type 2 Diabetes Using a Structural Equation Modeling Approach.

Electronic health (eHealth) literacy is a relatively new concept used to determine health outcomes. However, it is not well known how eHealth literacy relates to health outcomes such as diabetes self-management. This study was designed to examine the relationships among eHealth literacy, self-efficacy, social support, and self-management in people with Type 2 diabetes. A cross-sectional design was used to examine secondary data from a field survey of people with Type 2 diabetes recruited from outpatient clinics from August to December 2021 ( N = 453). A structural equation model was used that first analyzed the measurement model using confirmatory factor analysis and then tested the hypothesized structural model to estimate the expected relationships among the study variables. The significance of the statistical estimates for the model was assessed based on the 95% bias-corrected bootstrap confidence interval from 5,000 bootstrap resamples. Significant, indirect relationships were found between eHealth literacy and self-management via self-efficacy (β = 0.26, B = 0.17, 95% CI [0.10, 0.24]) and via social support and, in turn, self-efficacy (β = 0.08, B = 0.05, 95% CI [0.04, 0.08]). eHealth literacy, social support, and self-efficacy together explained 58.1% of the variance in self-management. This study provides new evidence regarding how eHealth literacy relates to self-management in people with Type 2 diabetes via two indirect pathways, including self-efficacy alone and social support and self-efficacy in series. An eHealth literacy program for self-management should be developed in clinical practice that includes strategies for inducing synergistic effects from self-efficacy and social support on self-management in people with Type 2 diabetes.

Impact of social media usage on academic performance of university students: Mediating role of mental health under a cross-sectional study in Bangladesh.

Social media is undeniably more accessible and more appreciated today. It is undoubtedly one of the most crucial instruments for student communication. Mental health status can also meaningfully influence the students at the higher levels of the educational institutions. This study aims to evaluate the social media usage of university students and its impact on academic performance and mental health. To examine under confirmatory factor analysis (CFA) several scale measurements were confirmed by justifying the validity and reliability of several necessary indices and structural equation model. The mediation analysis was also estimated to evaluate the students' Social media addiction (employed Bergen Social Media Addiction Scale) under maximum likelihood estimation with 2000 bootstrapping and 95% bias-corrected bootstrap confidence intervals. This study shows that the usage of social media significantly improves academic performance on psychological well-being, with a Comparative Fit Index of 0.921 and an RMSEA of 0.06 indicating a good fit of the CFA model. Finally, we exhibit a strong statistically significant positive impact of social media usage on academic success, and as supporting the hypothesis, the study observed a positive mediating role of mental health between social media addiction and academic performance. The present research investigations produced unique results, that is, online social media enhances mental health and mediates the link between social media addiction and academic performance in Bangladeshi students. This finding also add to the empirical database on social media usage and have significant theoretical and practical ramifications.

Differences in participation between young adults with cerebral palsy and their peers: A cross-sectional multicentre European study

BackgroundChildren and adolescents with disabilities are known to participate less in most areas of life than their non-disabled peers. Objectives(1) To estimate differences in participation between young adults with cerebral palsy (CP) and their non-disabled peers; (2) to test the mediating role of financial difficulties and student status; (3) to test the moderating role of personal factors on participation difference; and (4) to test the moderating role of impairment. MethodsA cross-sectional study was conducted in young adults [19–28 years] with CP (n = 228) and non-disabled peers (n = 2861) in France, Germany and Sweden. Participation was assessed using the Questionnaire of Young People's Participation adapted for young adults (QYPP-YA). Differences in five domains of participation were estimated using structural equation modeling with WLSMV method and bias-corrected bootstrap confidence intervals. ResultsYoung adults with CP showed lower participation than others in all domains, with the largest difference in the "intimate relationships" domain (β = 1.71 bcCI95[1.46; 1.95]). Student status mediated the difference in "intimate relationships", "interpersonal relationships" and "independence". Women showed greater differences than men on "independence". Impairments moderated difference in participation. The less severely impaired young adults showed no difference with their non-CP peers in "interpersonal relationships", "social life" and "independence", but made autonomous everyday decisions more often than their peers. ConclusionsYoung adults with CP do not have the same opportunities to attain the participation level of non-CP people of the same age. Continuance of education could help to reduce participation difference in "interpersonal relationships” and "independence”.

Relationships among self-esteem, ego-resilience, and caregiver burden among families of children with hematologic and oncologic disease: A cross-sectional study

BackgroundPediatric hematology and oncology disease is a physically and emotionally demanding health condition for families. High self-esteem and ego-resilience among caregivers, which have recently gained increased recognition, might help ease caregiver burdens. Few studies, however, have simultaneously investigated the relationships between self-esteem, ego-resilience, and caregiver burden among caregivers of children with hematologic and oncologic disease. ObjectiveThe purpose of this study is to investigate the relationships between caregiver burden, self-esteem, and ego-resilience and examine whether ego-resilience plays a role in mediating the relationship between self-esteem and caregiver burden among family caregivers of children with hematologic and oncologic disease. DesignDescriptive correlational study. SettingThe outpatient clinic of the department of pediatric hematology and oncology at a flagship university hospital in a metropolitan city in South Korea. ParticipantsThe sample comprised 109 primary family caregivers of children with hematologic and oncologic disease. Convenience sampling method was used. MethodsThe participants completed the Ego-Resiliency Scale, Rosenberg Self-Esteem Scale, and Family Burden Questionnaire. One-way analysis of variance, independent t-tests, and correlation analyses were conducted using IBM SPSS 25.0. The mediating effect of ego-resilience was estimated using the PROCESS macro and bootstrap method in SPSS. ResultsCaregiver burden showed significant negative associations with self-esteem and ego-resilience, with moderate effect sizes (r = −.391 and −0.361, respectively, p = .001). Ego-resilience mediated the relationship between self-esteem and caregiver burden (b = −0.019; 95 % bias-corrected bootstrap confidence interval −0.035 and −0.001). ConclusionsSelf-esteem and ego-resilience may lessen caregiver burden among families of children with hematologic and oncologic disease, and self-esteem of caregivers tends to promote their ego-resilience. Therefore, self-esteem and ego-resilience should be improved among family caregivers to reduce their caregiver burden.

노인요양병원 간호사의 촉진적 의사소통능력, 노인돌봄태도와 노인간호실천과의 관계에서 도덕적 민감성의 매개효과

Purpose : The purpose of this study was to investigate moral sensitivity and their mediating effects on the relationship among facilitative communication, attitude toward caring and performing older adult care in geriatric hospital nurses.
 Method : In total, 202 individuals participated in the cross-sectional study. Data were collected from August to October 2022 using structured questionnaires. The data were analyzed using multiple regression and a simple mediation model applying the PROCESS Macro with 95% bias-corrected bootstrap confidence interval( 5,000 bootstrap resampling).
 Result : Older adult care performance was significantly associated with facilitative communication (r＝.88, p＜.001), attitude toward caring (r＝.76, p＜.001), and moral sensitivity (r＝.68, p＜.001). Using PROCESS Macro Model 4, care performance was found to be directly affected by facilitative communication (β＝.88, p＜.001) and attitude toward caring (β＝.76, p＜.001). Moral sensitivity was directly affected by facilitative communication (β＝.67, p＜.001) and attitude toward caring (β＝.75, p＜.001). The partial mediating effects of moral sensitivity (β＝.76, p＜.001, 95% confidence interval 0.06∼0.19) in facilitative communication’s impact on care performance and (β＝.57, p＜.001, 95% confidence interval 0.11∼0.38) on the impact of attitude toward caring on older adult care performance were confirmed.
 Conclusion : The findings indicate that education strategies that can simultaneously increase facilitative communication, attitude toward caring and moral sensitivity are more effective when developing education programs that enhance the care performance of geriatric hospital nurses. Cultivating moral sensitivity will further promote geriatric hospital nurses' older adult care performance.

Dread and unknown characteristics of particulate matter pollution: cognitive and affective routes to air pollution prevention

This study investigates the effect of dread and unknown risks on individuals’ cognitive and affective responses and decision-making related to particulate matter (PM) air pollution. In particular, we investigate how dread and unknown risks play different roles in forming the cognitive and affective routes that affect the South Korean public’s intentions to reduce PM air pollution by adopting risk mitigation behaviors. One thousand South Korean adults participated in the study via a professional research company in 2022. Statistical analysis was performed using PROCESS Marco. Indirect effects and their significance were estimated using bias-corrected bootstrap (n = 5,000 resampling) confidence intervals (CIs). According to the results, perceived dread of PM air pollution had significant and positive associations with perceived health risks and negative emotion, and perceived risks had a significant and positive association with negative emotion. Moreover, the perceived unknown-ness of PM air pollution had a significant and positive association with perceived uncertainty, which had a significant and negative association with negative emotion. Our mediation models demonstrate that the cognitive and affective routes associated with the two risk dimensions had different effects on behavioral intentions to reduce PM air pollution. These distinct cognitive and affective routes have significant theoretical implications for the effective application of the psychometric paradigm in addressing various risk-related issues. The findings also imply that an appropriate level of negative emotion is crucial to motivate the public’s engagement in risk-reduction behaviors. While employing campaign messages that integrate perceived risk and negative emotional appeals derived from dread can be effective, caution should be taken not to diminish the public’s negative emotions when addressing the risk-related uncertainty in campaigns or interventions. Overall, our findings not only have several practical implications for environmental communication strategies but also make important theoretical contributions to the literature on risk perceptions and the psychometric paradigm.

Nonparametric Bootstrap Confidence Intervals for the Population Mean of a Zero-Truncated Poisson-Lindley Distribution and Their Application

Recently, the zero-truncated Poisson-Lindley distribution has been proposed for studying count data containing non-zero values. However, the nonparametric bootstrap confidence interval estimation of the population mean has not yet been studied. In this study, confidence interval estimation based on percentile, simple, and biased-corrected bootstrap methods was compared in terms of coverage probability and average interval length via Monte Carlo simulation. The true values of parameter () were set as 0.25, 0.5, 1, 1.5, and 2, and the population means are approximate 7.7586, 4.0909, 2.4000, 1.8817, and 1.6364, respectively. The bootstrap samples (=1,000) of size were generated from the original sample, and each simulation was repeated 1,000 times. The results indicate that attaining the nominal confidence level using the bootstrap confidence intervals was impossible for small sample sizes regardless of the other settings. Moreover, when the sample size was large, the performance of the nonparametric bootstrap confidence intervals was not substantially different. Overall, the bias-corrected bootstrap confidence interval outperformed the others, even for small sample sizes. Last, the nonparametric bootstrap confidence intervals were used to calculate the confidence interval for the population mean of the zero-truncated Poisson-Lindley distribution via two numerical examples, the results of which match those from the simulation study.

Factors influencing health-related quality of life for young single-person households: the mediating effect of resilience

Purpose: To identify factors influencing health-related quality of life for young single-person households, this study investigated physical and mental health status, health behavior, depression, resilience, and health-related quality of life. Methods: An online survey was administered to members of young single-person households from March 22 to 30, 2022. The data were analyzed using the chi-square test, independent t-test, one-way analysis of variance, Pearson correlation coefficients, multiple regression, and a simple mediation model applying the PROCESS macro model 4 with 95% bias-corrected bootstrapped confidence intervals. Results: The participants were 229 members of young single-person households. Health-related quality of life showed significant relationships with residence (t = 2.80, p = .006), monthly income (F = 3.70, p = .026), mental health status (F = 20.33, p < .001), and high-intensity exercise (F = 7.35, p = .001) among general and health-related characteristics. Health-related quality of life had significant correlations with depression (r = -.72, p < .001) and resilience (r = .58, p < .001). Multiple regression analysis showed that depression (β = -.57, p < .001) and resilience (β = .21, p < .001) influenced health-related quality of life. Moreover, resilience had a mediating effect between depression and health-related quality of life (indirect effect = -0.002, 95% bias-corrected bootstrapped confidence interval = -0.003 to -0.001). Conclusion: Members of young single-person households tended to be more vulnerable to emergency situations, such as during the coronavirus disease 2019 pandemic, when lockdowns and quarantines were frequent. To improve health-related quality of life in young single-person households, people with high levels of depression or low levels of resilience need special attention and support to promote mental health.

Early adverse stress and depression severity: A pilot exploration of mediating psychological mechanisms.

To explore the associations between early adverse stress, attachment insecurity in adulthood (anxious and avoidant), pathological personality styles (self-criticism and dependency), difficulties in emotion regulation, and depression severity. Cross-sectional study of 178 outpatients diagnosed with major depression in Santiago, Chile. Participants filled the Childhood Trauma Questionnaire Short Form, the Experience in Close Relationships Scale, the Depressive Experience Questionnaire, the Difficulties in Emotion Regulation Scale, and the Patient Health Questionnaire-9 item. Full-information maximum likelihood path analyses with bias-corrected bootstrapped confidence intervals were conducted. Anxious attachment in adulthood and self-criticism mediated the association between early adverse stress and depression severity through their effects on difficulties in emotion regulation. Early adverse stress was not associated with avoidant attachment in adulthood and dependency; these variables were indirectly associated with depression severity. Difficulties in emotion regulation were exclusively directly related to depression severity, mediating the effects of the preceding variables. Our findings propose an integrative model for psychological mechanisms mediating between early adverse stress and depression. Difficulties in emotion regulation should be considered when treating adults with depression exposed to early adverse stress. The contribution of specific types of early adverse stressors and difficulties in emotion regulation should be further explored.

Mediating Effect of Quality of Sleep Moderated by Meaning in Life on the Relationship between Hwabyung and Suicidal Ideation in Middle-Aged Korean Women.

The purpose of this study was to determine the role of the quality of sleep and meaning in life in the process by which Hwabyung symptoms affect suicidal ideation in middle-aged Korean women. A total of 265 women aged 40-65 years were enrolled in an online survey. The study variables were measured using the Hwabyung, quality of sleep, meaning in life, and suicidal ideation scales. The data were analyzed using the PROCESS Procedure for SPSS Release 3.5 (Model 14) program with a 95% bias-corrected bootstrap confidence interval. Hwabyung symptoms in middle-aged women had a significant direct effect on suicidal ideation, and an indirect effect through the quality of sleep was also statistically significant. Meaning in life was found to significantly moderate the indirect effect of Hwabyung on suicidal ideation through the quality of sleep. In other words, the greater the meaning in life, the weaker the effect of Hwabyung on suicidal ideation through the quality of sleep. The Hwabyung of middle-aged women caused a psychological crisis and was a great threat to physical health by lowering the quality of sleep. The low quality of sleep and the increase in suicidal ideation due to Hwabyung pose a great threat to the survival of middle-aged women. It was found that it is very important to find meaning in one's life as an effective way to reduce suicidal ideation in middle-aged women.

Mediating the Worst of Both Worlds Effect with Facets of Criminal Thought Process: Moral Neutralization, Cognitive Impulsivity, and Their Interaction

ABSTRACT The Worst of Both Worlds (WBW) hypothesis holds that prior offending and substance use in combination is significantly more likely to lead to antisocial behavior than either prior offending or prior substance use alone. In an effort to better understand the mechanisms behind the WBW effect, we performed a causal mediation analysis in which moral neutralization and cognitive impulsivity served as mediators of the WBW-delinquency relationship in a group of 845 (406 boys, 439 girls) early adolescents. We then tested the indirect effect for each pathway using longitudinal data and bias-corrected bootstrapped confidence intervals. Results showed that moral neutralization, but not cognitive impulsivity or the neutralization x impulsivity interaction, mediated the relationship between WBW and delinquency. These findings indicate that moral neutralization may play a salient role in the WBW effect by linking offending-substance comorbidity to future antisocial behavior. There is a need for additional research, however, to ascertain how and why comorbid criminal offending and substance use/abuse link specifically to moral neutralization, whereas there appears to be no connection between crime-substance comorbidity and cognitive impulsivity.

Mediating Role of Depression Between Diabetes Management Self-Efficacy and Diabetes Self-Care Behavior Among Elderly Type 2 Diabetes Mellitus Patients in China.

To investigate the current status of diabetes self-care behavior and the association between depression, self-efficacy and self-care in a sample of Chinese elderly type 2 diabetes mellitus (T2DM) patients. A cross-sectional study with a convenient sample including 240 elderly T2DM patients collected the data of demographic characteristics, diabetes self-care behavior, self-efficacy and depression status. The difference of self-care behavior in different sample characteristics was compared by independent t-test. The Personal correlation analysis was employed to examine the correlation of study variables. The method of bootstrap was used to analyze mediating role of depression. Only 22.5% of patients reported better diabetes self-care behavior and depression partly mediated the association between self-efficacy and self-care behavior. The significant coefficient of path a (B = -0.052, p < 0.001) and path b (B = -0.423, p < 0.05) indicated negative associations of self-efficacy on depression, and depression on self-care behavior. The indirect effect (Path a × b) between self-efficacy and self-care behavior through depression was significant (B = 0.022, p < 0.05), the 95% bias-corrected bootstrap confidence interval was 0.004 to 0.006. Meanwhile, the mediating role of depression was not found significant among the participants reported 60-74 years old (B = 0.104, p < 0.001). But depression completely mediated this association among the participants reported 75-89 years old (B = 0.034, p > 0.05). The level of diabetes self-care behavior among the elderly T2DM patients in Dahu community of Anqing city was hardly optimistic. The self-efficacy focused intervention could be encouraged for community and clinicians to improve diabetes self-care behavior. Moreover, the prevalence of depression and T2DM is increasing in younger population. More work is needed to confirm these findings, especially conducting cohort studies on different populations.

Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction

Background: Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support. Methods: There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models. Results: There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates ( Figure ). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant. Conclusion: Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.

Impact of Bias Correction of the Least Squares Estimation on Bootstrap Confidence Intervals for Bifurcating Autoregressive Models

The least squares (LS) estimator of the autoregressive coefficient in the bifurcating autoregressive (BAR) model was recently shown to suffer from substantial bias, especially for small to moderate samples. This study investigates the impact of the bias in the LS estimator on the behavior of various types of bootstrap confidence intervals for the autoregressive coefficient and introduces methods for constructing bias-corrected bootstrap confidence intervals. We first describe several bootstrap confidence interval procedures for the autoregressive coefficient of the BAR model and present their bias-corrected versions. The behavior of uncorrected and corrected confidence interval procedures is studied empirically through extensive Monte Carlo simulations and two real cell lineage data applications. The empirical results show that the bias in the LS estimator can have a significant negative impact on the behavior of bootstrap confidence intervals and that bias correction can significantly improve the performance of bootstrap confidence intervals in terms of coverage, width, and symmetry.

The role of combined modifiable lifestyle behaviors in the longitudinal association between stressful life events and allostatic load in Australian adults

Allostatic load is a model that is used to quantify the physiological damage from exposure to stressors. Stressful life events are chronic stressors that can lead to an elevated allostatic load through the physiological and behavioral stress responses. However, there is limited empirical studies that has tested the proposed behavioural pathway. Our study addresses this gap by examining the mediating role of combined modifiable lifestyle behaviors in the 12-years longitudinal association between stressful life events and allostatic load among participants from the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study cohort. A latent profile analysis was performed to identify latent subgroups with distinct behavioral clusters based on five modifiable lifestyle behaviors (smoking, sedentary behavior, physical activity, alcohol consumption, and diet quality). We then used a sequential mediation model design with path analysis to test the mediating effect of these latent subgroups in the associations between stressful life events and three measures of allostatic load. Indirect effects were estimated using the product of coefficient approach and the statistical significance was determined by the 95% bias-corrected bootstrap confidence intervals with 1000 replications. We identified three latent subgroups: “least healthy lifestyle” (12%; n = 396), “moderately healthy lifestyle” (78.7%; n = 2599), and “most healthy lifestyle” (9.2%; n = 306). Exposure to stressful life events was not associated with the allocation of participants in latent subgroups. Compared to the “moderately healthy lifestyle” subgroups, we found that the “least healthy lifestyle” behavioral cluster was not associated with allostatic load. However, there was a significant inverse association between the “most healthy lifestyle” behavioral cluster and allostatic load. Overall, we did not find significant indirect effects between stressful life events and three measures of allostatic load via the “least healthy lifestyle” and the “most healthy lifestyle” groups. In summary, the combinations of modifiable lifestyle behaviors did not explain the association between stressful life events and allostatic load. More longitudinal studies are needed to replicate our study to confirm this finding.

The role of uncertainty and affect in decision-making on the adoption of AI-based contact-tracing technology during the COVID-19 pandemic.

This study explores how negative affect, perceived net equity, and uncertainty influence the public's privacy decision-making regarding the adoption of contact-tracing technology based on artificial intelligence (AI) during the COVID-19 pandemic. Four hundred and eighteen adults in the US participated in the study via Amazon Mechanical Turk in August 2020. Statistical analyses were performed using the PROCESS macro. Indirect effects and their significance were estimated using bias-corrected bootstrap confidence intervals (CIs) with resampling set to n = 5000. Perceived net equity was positively associated with low levels of perceived uncertainty regarding a COVID-19 contact-tracing application and intention to adopt it. Low levels of perceived uncertainty were positively associated with intentions to adopt such an application, thereby suggesting that a perceived level of uncertainty mediates the association between perceived net equity and adoption intentions. Anxieties regarding AI technology and COVID-19 risks both moderate the associations among perceived net equity, perceived level of uncertainty, and intentions to adopt the contact-tracing technology. Our findings highlight how the differing sources of emotion influence the associations among rational judgment, perceptions, and decision-making about new contact-tracing technology. Overall, the results suggest that both rational judgments and affective reactions to risks are important influencers of individuals' perceptions and privacy-related decision-making regarding a new health technology during the pandemic.

Metabolic health disparities driven by financial stress: Behavioural adaptation or modification?

Financial stress has been linked to an increased risk of metabolic syndrome, yet, it remains unclear whether suboptimal sleep duration and physical inactivity are the adaptive responses to financial stress or effect modifiers in the association between financial stress and metabolic syndrome. Hence, this study aims to examine whether physical activity and sleep duration mediate or moderate the bivariate association between financial stress and metabolic syndrome. A prospective secondary analysis was conducted using data from the Wisconsin Sleep Cohort Study (N=445, mean [SD] age=64 [7] years). Baseline moderation effect was examined using subgroup analysis with model constraints; prospective mediation model was examined using bias-corrected bootstrap confidence intervals. Results indicate that participants with higher financial stress were less likely to meet physical activity and sleep recommendations. Baseline moderation analysis indicates that meeting current recommendations of sleep duration and physical activity attenuated the association between financial stress and metabolic syndrome. In the prospective mediation analysis, weekly physical activity levels partially mediated the relationship between financial stress and metabolic syndrome, but sleep duration did not mediate this relationship. In conclusion, the joint effect of optimal sleep duration and physical activity disassociates financial stress from the risk of metabolic syndrome. Future interventions addressing metabolic risk might achieve better outcomes if clinicians and researchers factor in the behavioral adaptation of physical inactivity in financially stressed adults (Clinical Trial Registration: NCT00005557).

Mediating Effects of Rehabilitation Motivation between Social Support and Health-Related Quality of Life among Patients with Stroke.

Post-stroke health-related quality of life (HRQoL) is poor, which is related to low social support levels and lack of rehabilitation motivation. However, there are limited studies that have systematically analyzed the mechanisms underlying this relationship in stroke patients. This study aimed to identify the mediating effects of rehabilitation motivation on the relationship between social support and HRQoL among stroke patients. A cross-sectional descriptive study was conducted on 176 Koreans aged ≥19 years who were admitted for rehabilitation treatment after stroke at three general hospitals in Jeonbuk. Data collection was conducted from September to December 2020 through face-to-face interviews using structured questionnaires and review of medical records. The significance of the mediation model was tested using SPSS 25.0 and the PROCESS macro for SPSS v3.5. Significant associations were identified between social support and HRQoL. Our findings revealed an indirect effect, suggesting that the effects of social support on HRQoL are mediated by rehabilitation motivation (B = 0.004, 95% bias-corrected bootstrap confidence interval = 0.002, 0.006). Social support for stroke patients had a positive effect on HRQoL, and rehabilitation motivation was found to have a partial mediating effect on this relationship. This study suggests that social support from healthcare professionals and families for post-stroke can improve patients' HRQoL by inducing positive rehabilitation motivation. Therefore, developing intervention strategies to motivate rehabilitation could improve the HRQoL of patients with stroke.

Work stress, burnout, occupational commitment, and social support among Chinese pediatric nurses: A moderated mediation model

PurposePediatric nurses are at high risk for burnout, resulting in unsatisfactory care quality. Although job resources like social support can prevent the development of burnout under work stress, the mediating role of personal resources like occupational commitment is not well studied. This study was to examine the mediating role of occupational commitment in the relationship between work stress and burnout, and test if the effect of work stress on occupational commitment varies at different levels of social support among pediatric nurses. MethodsA cross-sectional survey was conducted to collect data of pediatric nurses from 6 hospitals in Chengdu, China. Multiple linear regressions and bias-corrected bootstrap confidence intervals were used to test the proposed model. ResultsIn this sample of 488 pediatric nurses, work stress was significantly associated with emotional exhaustion (β = 0.278, p < 0.001), depersonalization (β = 0.112, p < 0.001), and personal accomplishment (β = −0.047, p < 0.05). Occupational commitment partly mediated the links of work stress and emotional exhaustion (β = 0.056, 95%CI: 0.034–0.082), and depersonalization (β = 0.026, 95%CI: 0.014–0.041), and fully mediated the relationship between work stress and personal accomplishment (β = −0.059, 95%CI: −0.080 ∼ −0.039). Social support significantly moderated the relationship between work stress and occupational commitment (β = 0.007, p < 0.01). ConclusionAmong pediatric nurses, work stress has an indirect influence on burnout through occupational commitment, and such an effect is weakened when social support is high. Practice implicationsNurse managers could consider developing interventions by promoting both occupational commitment and social support to prevent burnout of employees.