Indirect effects refer to the population-level effects of vaccination on vaccinated and unvaccinated individuals, including herd protection, serotype replacement, and age shifts, which can substantially impact the real-world effectiveness of vaccination programs. Despite their importance, most economic evaluations omit indirect effects, likely owing to the complexity of underlying mechanisms, data limitations, and difficulties in disentangling confounding factors. Static models and dynamic transmission models (DTMs) are two common approaches for incorporating indirect effects in economic evaluations. Static models rely on simplified assumptions and readily available data but often overlook the temporal and population-level dynamics of disease transmission. In contrast, DTMs account for complex factors (e.g., population mixing, serotype competition, and long-term epidemiological changes) but require more complex model structure and extensive data. In this article, we illustrate the applications, strengths, and limitations of these two modeling approaches through case studies. We demonstrate how choices of model structure and assumptions, data sources, and parameter estimation methodologies can influence projected epidemiological and economic outcomes, sometimes leading to divergent conclusions. While international guidelines increasingly recognize the importance of including indirect effects in economic evaluations, limited methodological guidance from National Immunization Technical Advisory Groups (NITAGs) and health technology assessment (HTA) bodies continues to hinder consistent implementation. This paper advocates for a collaborative effort among stakeholders to generate high-quality surveillance data and establish guidelines for methodological considerations to model indirect effects. Such efforts will improve the accuracy of epidemiological and economic assessments of vaccination programs and strengthen evidence-based decision-making in public health.

Selective serotonin reuptake inhibitors (SSRIs) are a recommended first line medication for the treatment of major depressive disorder, due to higher tolerability and lower risk of adverse effects than other antidepressants. The mechanisms by which SSRIs reduce depressive symptoms are not well understood, but are hypothesised to include direct effects on serotonin signalling and synaptic remodelling, and indirect effects on inflammation. Indirect or off-target effects may be detectable in blood and can be investigated using methylome- and transcriptome-wide approaches. The Staged Treatment in Early Psychosis (STEP) clinical trial included a 6-month long randomised, placebo-controlled trial of the SSRI fluoxetine in a cohort of young people at ultra-high risk for psychosis. A methylome-wide association study (MWAS; NTotal (before/after/both)=104 (52/52/44), NSSRI (before/after/both)=45 (21/24/18)) and differential expression analysis were performed on longitudinal blood samples collected at the start and end of the 6months to identify changes in DNA-methylation and gene expression associated with medium-term SSRI exposure. Four methylation CpGs (cg26253898, cg09719563, cg22216017, cg26017656) were significantly associated with SSRI exposure (FDR < 0.1, 2 CpGs at FDR < 0.05) and annotated to genes involved in glucose metabolism, synaptic remodelling and inflammation (GCG, COL23A1, PEG10, SGCE, MFGE8). Gene-set enrichment analyses of genes annotated to the top 100 CpGs identified significant tissue-specific enrichments in artery, adipose and spleen tissues, and in the 'postsynaptic density' GO term. No genes were differentially expressed, including genes annotated to the significant methylation CpGs. Medium-term SSRI use during the STEP trial was associated with changes in DNA-methylation that may partially explain the potential antidepressant mechanisms and adverse effects of SSRIs, however replication in other cohorts is necessary to establish if these changes are generalisable to SSRI use more broadly.

Pathways linking childhood emotional abuse and neglect to punitive attitudes: The role of interpersonal trust and emotion regulation.

Italian validation of the subjective vitality scale. Relationships with extraversion, emotional stability, and basic psychological need satisfaction.

Introduction: Integrated care (IC) is pivotal to China’s primary healthcare reform under Healthy China 2030. Multidisciplinary family doctor teams (FDTs), with variable compositions, aim to deliver IC but face performance inconsistencies. While prior studies associate team composition with clinical outcomes, they neglect to elucidate the underlying mediating mechanisms. This study examines the association between FDT composition and IC, and whether inter-professional collaboration (IPC) may act as a mediator in this relationship. Methods: This cross-sectional study surveyed 224 stratified-randomly sampled FDTs in Guangzhou in August 2023. Validated instruments were used to measure IPC and IC. We evaluated the potential mediating role of IPC using bias-corrected bootstrap procedures, and conducted a path analysis to explore the associations between IPC and IC. Results: For standard teams compared with basic teams, the total effect on IC was not significant (B = 1.986, 95% CI: –0.719 to 4.691). The indirect effect via IPC was significant (B = 1.743, 95% CI: 0.490 to 3.128), while the direct effect was not significant (B = 0.243, 95% CI: –2.157 to 2.643). For advanced teams, the total effect was significant (B = 7.386, 95% CI: 4.316 to 10.456). Both the direct effect (B = 5.351, 95% CI: 2.624 to 8.077) and the indirect effect via IPC (B = 2.035, 95% CI: 0.548 to 3.492) were significant. Path analysis further examined the structural associations between IPC and the multifactorial components of IC. Conclusion: For advanced teams, team composition was positively associated with IC, with IPC partially mediating this relationship. For standard teams, only the indirect effect via IPC was significant.

In Zambia, clearing land for cultivation is a reported mechanism for making land claims in contexts of uncertain rights and expropriation risk, and leaving land fallow is less common for those with weaker land rights. When only some farmers in a village obtain land title, the land security of untitled landholders, particularly women, can become less secure in contexts where there are fears that chiefs can reallocate land away from untitled smallholders to obtain financial gains from seekers of titled land. On the other hand, if village-level titling signals a general transition towards more transparent regulation and/or more favorable developmental prospects for the area, then local trends in titling may contribute to an increased shared sense of tenure security, even for non-title-holders. Motivated by these hypothesized effects, we examine whether neighborhood titling rates are positively or negatively associated with smallholders leaving land virgin or fallow, after controlling for own-titling status. We show that both own-title status and neighboring titling rates are positively associated with having farmland in virgin and fallow states, i.e., reduced incidence of land clearing, indicating that community titling rates are associated with increased security and expected future returns on uncultivated land. However, these results vary by gender: community titling rates are less strongly associated with decreased land conversion by female household heads (except in the case of leasehold titling) who often have weaker bargaining rights in customary systems. Additionally, we show that, after controlling for one’s own land titling status, neighbors’ titling is associated with greater rental market participation and more longer-term productivity investments. These indirect effects are stronger for leasehold titling as compared with customary land certification, and for titles which have been finalized (compared with titles still being processed). Our analysis indicates that tenure formalization policies may have both direct and indirect effects which differ by type of actor. • We present nationally representative land titling and certification rates in Zambia. • Titling is associated with lower pressure to convert virgin land (clearing to claim). • Titling is also associated with a variety of productive smallholder land investments. • These associations are stronger for formal titling than customary land certification. • Local titling/certification outcomes also induce investment by non-titled neighbors.

A structural equation modeling based on the conservation of resources theory: Analyzing the relations between artificial intelligence attitude, employability, and career stress in nursing students.

Sedentary behavior and physical health status explain the relationship between years of residence in socioeconomically distressed counties and risk for Cardiovascular diseases.

Early childhood development is profoundly influenced by parent-child interaction yet the impact of parental knowledge, attitude and practice (KAP) regarding screen exposure and home environment on these dynamics remains underexplored. This study investigates the associations between parental KAP on screen exposure, home nurture environment and parent-child interaction quality in children aged 2-3 years, addressing a critical gap in understanding how digital media habits shape early developmental contexts. A cross-sectional study was conducted with 252 parents of children aged 2-3 years. Data were collected through validated questionnaires assessing parental KAP on screen exposure, parent-Child screen, home nurture environment and parent-child interaction quality. Structural equation modelling was employed to analyze direct and indirect pathways between variables. Parent-child screen exhibited a significant positive direct effect on parent-child interaction (β = 0.540, p < 0.01). The child home nurture environment had a significant positive direct effect on parent-child interaction (β = 0.366, p < 0.01) and also exerted an indirect positive effect on parent-child interaction through parent-child screen (β = 0.320, p < 0.01). Parental KAP regarding children's screen exposure exerted an indirect positive effect on parent-child interaction (β = 0.440, p < 0.01) through two pathways: one through the single mediating effect of child home nurture environment, and the other through the chain mediating effect from the child home nurture environment to parent-child screen. Supportive home environment and proactive parental engagement are pivotal in fostering positive parent-child interaction amidst rising screen exposure. Interventions targeting KAP improvement and balanced screen-use practices could enhance early childhood development. This study underscores the need for policy and educational programs to empower parents in creating nurturing, screen-smart home environment for early childhood.

Triazine herbicide prometryn impaired trophic link between phytoplankton and zooplankton Brachionus plicatilis by diminishing polyunsaturated fatty acids contents.

Acute intermittent hypoxia (AIH) induces phrenic long-term facilitation (pLTF), a sustained increase in phrenic motor output that arises from the balance of competing serotonin- and adenosine-driven mechanisms. Due to shifts in spinal adenosine levels, pLTF exhibits a diurnal cycle, where 15, 1-min hypoxic episodes elicit robust serotonin-dependent pLTF during the diurnal rest phase (∼130%) but are markedly attenuated in mid-active phase rats (∼30%) due to undermining effects from elevated spinal adenosine. Mechanistic studies of pLTF typically use anesthetized, paralyzed, mechanically ventilated rats with bilateral cervical vagotomy to prevent ventilator entrainment. However, vagotomy increases arterial pressure, which may protect spinal cord perfusion during hypoxic episodes. Here, we tested the hypothesis that intact vagus nerves diminish spinal oxygenation and pLTF expression. Rats with intact vagus nerves had lower arterial pressure and spinal cord oxygen tensions during hypoxic episodes, despite equivalent hypoxemia. As spinal cord hypoxia promotes adenosine accumulation, expected to constrain serotonin-driven pLTF, we hypothesized that intact vagal feedback blunts rest-phase pLTF and abolishes diurnal variations in response to AIH (15, 1-min episodes). With intact vagi, increased phrenic burst amplitude 90 min post-AIH was markedly attenuated in the mid-rest (43 ± 63% baseline), but not mid-active phase (43 ± 25%), suppressing the magnitude of diurnal variation. Cervical spinal delivery of the A2a receptor antagonist MSX-3 restored robust pLTF in both diurnal phases; selective A2a receptor knockdown within phrenic motor neurons enhanced pLTF during mid-rest but not mid-active phase. Thus, intact vagus nerves indirectly shift the spinal serotonin/adenosine balance during hypoxia, suppressing diurnal variations in pLTF magnitude.NEW & NOTEWORTHY Acute intermittent hypoxia (AIH) induces phrenic long-term facilitation (pLTF) via competing serotonin versus adenosine-driven signaling cascades. pLTF mechanisms are typically studied in anesthetized, vagotomized rats. We report in anesthetized rats that intact vagus nerves: 1) lower blood pressure and spinal oxygen tension during hypoxic episodes; 2) increase the adenosine constraint of serotonin-driven pLTF; and 3) abolish diurnal variations in pLTF magnitude. Thus, vagal feedback regulates pLTF via indirect effects on the spinal serotonin/adenosine balance.

Food insecurity and verbal aggression toward children: Income-differentiated pathways through parental psychological distress.

Body dysmorphic concerns (BDC) are closely connected to the severity of psychotic symptoms in people diagnosed with schizophrenia. At the same time, there is evidence suggesting that BDC is related to alarmingly increased rates of suicidality, and suicidality is a predictor of increased psychotic symptoms. Investigating these pathways may provide insight into the complex interaction between psychopathology and psychotic symptoms, and inform future intervention strategies. Using a clinical sample of outpatients with first-episode schizophrenia and a non-clinical sample of healthy adults, the objectives of this study were twofold: (1) to explore the nature and prevalence of BDC symptoms in both samples and (2) to examine the mediating influence of suicidal thoughts on the association between BDC and psychotic symptoms in the patients' sample. The research was cross-sectional, performed over a period of 6 months, from 1 July 2024 to 31 December 2024. Our target population consisted of two groups: (1) a group of clinically-stable outpatients recruited at the first episode of schizophrenia and who have less than 3 months of lifetime exposure to antipsychotic medication and (2) a group of healthy controls. A total of 103 patients and 109 controls were included for final analysis. Our results indicated that patients were at higher risk for experiencing body dysmorphic disorder (41.7%) than controls (16.5%). Mediation analysis showed that the effect of BDC on psychotic symptoms severity was partially mediated by suicidal ideation (indirect effect: Beta = 0.281; Boot SE = 0.122; Boot CI 0.034; 0.520). On one hand, BDC directly correlated with greater levels of psychotic symptoms. On the other hand, dysmorphic concerns significantly correlated with more suicidality, which was, in turn, correlated with more intense psychotic symptoms. Our findings suggest that the improvement of BDC symptoms coupled with suicide risk assessment and intervention should be integrated into strategies designed to aid the management of psychotic symptoms in schizophrenia.

Digital literacy and scientific research ability among nursing postgraduates: The chain-mediating role of deep learning and research self-efficacy.

Linking effort-reward imbalance to work engagement: Job crafting as a mediator and overcommitment as a moderator among rural teachers.

Psychological safety and teacher voice behavior: Power distance orientation in Chinese schools.

Professional values are fundamental determinants of nursing care quality and ethical practice. Self-compassion has emerged as an important psychological resource that may support nurses' well-being and caregiving performance, particularly in demanding environments such as intensive care units. However, limited evidence exists regarding the relationships among professional values, self-compassion and caring behaviours in intensive care nurses. To examine the relationships between intensive care nurses' professional values, self-compassion and caring behaviours and to determine the mediating role of self-compassion in the relationship between professional values and caring behaviours. A descriptive and correlational study was conducted in the intensive care units of a university hospital in eastern Türkiye between November 2025 and February 2026. Data were collected using the Personal Information Form, Nurses' Professional Values Scale, Short Form Self-Compassion Scale, and Caring Behaviors Inventory. Descriptive statistics, Pearson correlation analysis, hierarchical regression analysis, and PROCESS Macro (Model 4) mediation analysis were used. A total of 134 intensive care nurses participated in the study. Professional values and caring behaviours were high (149.91 ± 12.02 and 167.32 ± 16.73, respectively), whereas self-compassion was moderate (36.66 ± 8.41). Significant positive correlations were found among professional values, self-compassion, and caring behaviours (p < 0.01). Professional values significantly predicted self-compassion (β = 0.418) and caring behaviours (β = 0.580), while self-compassion significantly predicted caring behaviours (β = 0.222). After controlling for gender, income status, unit of work, and number of patients cared for, self-compassion partially mediated the relationship between professional values and caring behaviours (indirect effect = 0.129; 95% CI: 0.036-0.223). The model explained 53% of the variance in caring behaviours. Professional values influence intensive care nurses' caring behaviours both directly and indirectly through self-compassion. Self-compassion appears to be an important psychological mechanism that strengthens the positive effect of professional values on caring behaviours. Enhancing self-compassion may contribute to improving nursing care quality in intensive care settings. Interventions aimed at strengthening self-compassion and educational programmes that promote professional values may enhance caring behaviours among intensive care nurses and improve the quality of patient care.

Bystander effects of a photoactivated ruthenium-based complex in 2D and 3D cell culture models.

Burning for a warm glow: The impact of acute exercise on mood and prosocial behaviour.

Passive social networking, peer group pressure and procrastination on academic tasks: Time management skill as a mediator and academic self-efficacy as a moderator.