Mediation Analysis Research Articles

Bayesian Multilayered Mediation Analysis for Cancer Pharmacogenomics

ABSTRACTMultiomic data from multilevel biological systems are becoming common and motivate integrative modelling approaches to decipher within‐ and cross‐platform dependencies. Mediation analysis aims to identify mediating mechanisms that regulate the effect of an exposure on an outcome. In multiomic contexts, identification of genomic mediators of disease outcomes provides a deeper understanding of mechanisms of disease and corresponding therapeutic targets. While there has been significant work on joint modelling of high‐dimensional potential mediators, approaches that can identify individual mediators in presence of high‐dimensional potential mediators are lacking. We posit that the multiomic data are interrelated following multilayered Gaussian graphical models that include undirected and directed acyclic graphs as special cases. We develop a Bayesian inferential framework for multilayered mediation analysis with continuous, binary, and ordinal outcomes using probit models. As opposed to existing approaches focusing on identifying joint mediation effects, we decompose the joint effect into effects attributable to individual mediators in the framework of interventional mediation analysis. Simulations demonstrate our method outperforms other existing approaches to identify mediators that have nonzero indirect effects to the outcome. We apply our method to multiomic analysis on drug sensitivity outcomes of palbociclib and agents for endocrine therapy, standard care for breast cancer.

Earlier Age at Menopause, Plasma Metabolome, and Risk of Premature Mortality

Background/Objectives: Menopause and related metabolites are associated with mortality. However, the relationship between earlier menopause, premature mortality, and the role of metabolomic signatures remains underexplored. This study investigated the association between earlier menopause and premature mortality, and the mediating effect of metabolomic signatures. Methods: This prospective cohort study used data from the UK Biobank, including 33,687 post-menopausal women aged 40–69 years. Age at menopause was obtained from a baseline self-reported questionnaire and analyzed both as a continuous variable and in categories (<40, 40–49, and ≥50 years). Premature mortality was defined as deaths before 75 years. Cox regression was used to estimate hazard ratios (HRs), and elastic net regression identified metabolomic signatures related to menopause age. Mediation analysis was conducted to assess the proportion of the association explained by the metabolomic signature. Results: During a median follow-up of 13.7 years, 1612 cases of premature mortality occurred. Compared to menopause at ≥50 years, earlier menopause (HR 1.17, 95% CI 1.04–1.30) and premature menopause (HR 1.60, 95% CI 1.28–2.00) were associated with higher risks of premature mortality. A metabolomic signature inversely associated with premature mortality (HR per SD increment, 0.79; 95% CI, 0.75–0.83) mediated 13.6% (95% CI, 1.9%–28.3%) of the association between earlier menopause and premature mortality. Conclusions: Earlier menopause is associated with an increased risk of premature mortality, partially mediated by a metabolomic signature related to age at menopause. These findings highlight the importance of metabolomic profiling in understanding menopause and mortality risks.

Nutritional status and triglyceride-glucose index influence delirium in elderly heart failure patients

Malnutrition and insulin resistance are linked to complications like delirium, yet their impact on elderly heart failure patients remains underexplored. This study investigates how nutritional status and the triglyceride-glucose (TyG) index influence delirium in this population. We conducted a retrospective study involving patients aged 75 and older with decompensated heart failure. Delirium was assessed using the Confusion Assessment Method (CAM), and nutritional status was evaluated with the Mini Nutritional Assessment Scale-Short Form (MNA-SF). The TyG index was calculated as: TyG index = ln [triglycerides (mg/dL) × fasting glucose (mg/dL) / 2]. The study included 412 patients (mean age 84.30 ± 5.16 years; 56.31% male), with 24.03% experiencing delirium during hospitalization. After adjusting for confounders, a higher TyG index was significantly associated with increased delirium risk (OR = 1.549, 95% CI: 1.102–2.178, P = 0.012), while a higher MNA-SF score correlated with reduced risk (OR = 0.793, 95% CI: 0.662–0.949, P = 0.011). Kaplan-Meier analysis showed significant differences in cumulative survival based on nutritional status and TyG index (Log-Rank test: χ²= 65.604, P < 0.001). Mediation analysis indicated that nutritional status partially mediated the relationship between the TyG index and delirium, and vice versa. Malnutrition and elevated TyG index levels increase delirium risk in elderly heart failure patients, underscoring the need for effective nutritional management and metabolic regulation.

Direct impact of psoriasis on gingival crevicular fluid levels of VEGF-A in periodontitis patients: a mediation analysis

Direct impact of psoriasis on gingival crevicular fluid levels of VEGF-A in periodontitis patients: a mediation analysis

Associations between gestational exposure to perfluoroalkyl substances, fetal growth, and the mediation effect of thyroid hormones

Prenatal exposure to perfluoroalkyl and polyfluoroalkyl substances (PFASs) may cause adverse birth outcomes. Thyroid hormones may play a key role in mediating the effects of PFAS. We enrolled 374 mother-infant pairs from the Ezhou birth cohort study between 2019 and 2020. Eight PFASs and six thyroid hormones were measured in maternal serum during the first trimester of pregnancy. Neonatal growth metrics, including birth weight, length, head circumference, and gestational age, were acquired. Multivariate linear regression was performed to determine the associations between maternal serum PFAS and thyroid hormone levels and birth outcomes and a mediation analysis was also conducted. Except for perfluoroheptanoic acid (41.2%), the other seven PFAS detection rates were more than 85%, and the highest median concentration was observed for PFOSA with levels of 5.21 ng/mL. After controlling for typical confounders, we observed a decrease in birth length (cm) with increasing serum concentrations of perfluorononanoic acid (PFNA) (β = -0.54; 95% CI = -1.0, -0.08) and perfluorohexane sulfonate (PFHxS) (β = -0.64; 95% CI = -0.86, -0.42). Additionally, a decrease in birth head circumference was observed with increasing concentrations of perfluorooctanote (PFOA) (β = -0.73, 95% CI = -1.19, -0.27) and PFHxS (β = -0.30; 95% CI = -0.53, -0.07). Maternal free triiodothyronine (FT3) mediated 36.7% of the negative association between PFNA and birth length, and free thyroxine (FT4) mediated 30.8% of the effect of PFOA on head circumference. When performing stratified analysis by infant sex, the associations might differ between boys and girls. Our study suggested prenatal exposure to some PFASs was negatively associated with birth length and circumference, and FT3 and FT4 may partly mediate the association.

The association between preserved ratio impaired spirometry (PRISm) and cognitive function among American older adults: the mediating role of systolic blood pressure

BackgroundRecent studies have drawn attention to the association between preserved ratio impaired spirometry (PRISm) and cognitive function decline. High systolic blood pressure (SBP) is a known risk factor for both PRISm and dementia. This study aimed to investigate whether elevated SBP may mediate the relationship between PRISm and cognitive function in older adults.MethodsThis study analyzed 732 participants aged ≥ 60 years who had completed spirometry and cognitive function tests in the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Multivariable linear regression was employed to assess the relationship between PRISm and cognitive function, as measured through the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning sub-test, the Animal Fluency test (AFT), the Digit Symbol Substitution test (DSST), and global cognition tests. All cognitive tests were modeled as z-scores, and global cognition was calculated as the sum of the z-scores of the CERAD, AFT, and DSST. Mediation analyses were conducted to test the mediating effect of SBP on the association between PRISm and cognitive function.ResultsParticipants with PRISm had lower AFT (β = -0.300; 95% confidence interval [CI] = -0.479 to -0.122; p = 0.001), DSST (β = -0.157; 95% CI = -0.309 to -0.004; p = 0.044), and global cognition scores (β = -0.211; 95% CI = -0.369 to -0.053; p = 0.009) than those with normal spirometry, after adjusting for all potential confounders. SBP was considerably associated with AFT (β = -0.084; 95% CI = -0.162 to -0.005; p = 0.038) and DSST (β = -0.132; 95% CI = -0.207 to -0.057; p < 0.001), mediating 7.9% and 18.0% of the association of PRISm with cognitive function, respectively. Furthermore, SBP mediated 17.1% of the association of PRISm with global cognition.ConclusionsThe findings suggested the potential role of SBP as a mediator of associations between PRISm and cognitive decline in older adults.

Feasibility and Acceptability of a Palliative Care Intervention Among Older or Adults with Advanced CKD and their Caregivers.

In non-nephrology settings, specialty Palliative Care (PC) improves decision-making, patient's quality of life (QoL), advance care planning (ACP), and certain indicators of the quality of end-of-life (EoL) care. This pilot RCT explored the feasibility and acceptability of a PC intervention, CKD-EDU, for older adults ≥75 years with eGFR ≤25 ml/min and their caregivers. Participants randomized to the control group received standard nephrology care and routine kidney therapy (KT) education, while those randomized to CKD-EDU received a decision aid and met with a PC clinician up to three times to discuss KT decisions and EoL planning. Patients were assessed at baseline, 4-6, 12-14, and 24-26 weeks. Main outcomes included intervention feasibility and acceptability, decision-conflict, and patient QoL. The mediating effects of reduced decision conflict on improved QOL were explored, as were the effects of CKD-EDU on ACP, EoL treatment intensity and 6-month-hospitalization. Statistical analyses encompassed descriptive analyses, adjusted repeated-measure-models, mediation analyses and logistic-regression models. Among the 127 eligible patients screened, 58 (44%) consented: 30 were randomized to CKD-EUD and 28 to the control arm. All patients completed baseline assessments, and 89% completed at least one intervention session (n=26/29), underscoring intervention adherence and feasibility. Similarly, assessments completion rates at 4 (83%, n=45/54) ), 12 (93%, n=42/45), and 24 (95%, n=40/42) weeks were high. The intervention received over 85% acceptability ratings for all questions. Patients exposed to CKD-EDU exhibited significant improvement in decisional conflict scale scores (P = 0.003) at 4-6 weeks and improvements in QoL at 24-26 weeks (P=0.02). Exploratory analyses were not statistically significant in this pilot, but all effect sizes were in the predicted direction. This study demonstrates the feasibility and acceptability of CKD-EDU. A larger scale trial is warranted to assess its effectiveness in improving key outcomes important to patients and families.

Problematic Social Media Use, Retaliation, and Moral Disengagement in Cyberbullying and Cybervictimization Among Italian Preadolescents: A Moderated Mediation Model

AbstractDespite existing research on the factors associated with problematic social media use (PSMU), cyberbullying (CB), and cybervictimization (CV) among youth, few studies have explored the relationships between these variables. Rooted in the Maladaptive Coping Theory, this study investigates the complex dynamics of digital behaviors among Italian preadolescents, exploring the interplay between PSMU, moral disengagement, retaliation, and their connections with cyberbullying and cybervictimization. A total of 489 participants (Mage = 11.90, SD = 0.783; 50.3% female) from schools in southern Italy completed an online self-report questionnaire. Descriptive analyses were conducted and correlations between variables were computed. Mediation and moderation analyses were performed using PROCESS in SPSS 27.0. The results of the study indicated that PSMU positively predicted both CB and CV. Moral disengagement (MD) was identified as a mediator in this association, elucidating the role of justifications and cognitive restructuring in facilitating negative online behaviors. Most notably, retaliation emerged as a moderator that amplified the effects of PSMU on cyberbullying and cybervictimization. These findings underscore the pivotal role of PSMU in shaping digital landscapes for preadolescents and highlight the need for tailored interventions. In addition, they highlight MD as a maladaptive coping strategy in the online realm, revealing its instrumental role in perpetuating negative online behaviors. This study’s insights suggest the need for interventions to address the complexity of young people’s online interactions and promote a safer digital environment.

Managerial ability and firm growth: intellectual capital components

PurposeThis study analyses the way various components of intellectual capital (IC), namely, human capital (HC), structural capital (SC), relational capital (RC) and innovation capital (INNC), act as mediators in the relationship between managerial ability (MA) and a firm’s ability to achieve growth.Design/methodology/approachThis study employs data envelopment analysis to quantify the MA of 825 Taiwanese listed electronics companies from 2017 to 2022. The proxies of firm growth are return on asset growth, operating income growth and total asset growth. This study then utilises a three-step mediation analysis methodology to examine the relationships between MA, IC and firm growth.FindingsFindings indicate that HC, SC, RC and INNC mediate the link between MA and firm growth. This suggests that competent managers can capitalise on the potential benefits of these investments to achieve firm growth.Practical implicationsCompetent managers can utilise different IC investments to grow the financial performance and strength of their businesses. Managers should continually scan, secure opportunities and adjust their investments in knowledge assets in accordance with the dynamic capabilities view. That is, managers, in general, and operations managers, in particular, can implement guidelines that prioritise IC investments in the future to expedite firms’ development.Originality/valueThis study extends the existing frameworks that study investment variables as mediators between MA and firm outcomes. Most particularly, this study adopts four components of IC for measurement. Moreover, firm performance is measured using dynamic growth indicators rather than static measures.

Multiomic integration analysis identifies atherogenic metabolites mediating between novel immune genes and cardiovascular risk

BackgroundUnderstanding genetic-metabolite associations has translational implications for informing cardiovascular risk assessment. Interrogating functional genetic variants enhances our understanding of disease pathogenesis and the development and optimization of targeted interventions.MethodsIn this study, a total of 187 plasma metabolite levels were profiled in 4974 individuals of European ancestry of the GCAT| Genomes for Life cohort. Results of genetic analyses were meta-analysed with additional datasets, resulting in up to approximately 40,000 European individuals. Results of meta-analyses were integrated with reference gene expression panels from 58 tissues and cell types to identify predicted gene expression associated with metabolite levels. This approach was also performed for cardiovascular outcomes in three independent large European studies (N = 700,000) to identify predicted gene expression additionally associated with cardiovascular risk. Finally, genetically informed mediation analysis was performed to infer causal mediation in the relationship between gene expression, metabolite levels and cardiovascular risk.ResultsA total of 44 genetic loci were associated with 124 metabolites. Lead genetic variants included 11 non-synonymous variants. Predicted expression of 53 fine-mapped genes was associated with 108 metabolite levels; while predicted expression of 6 of these genes was also associated with cardiovascular outcomes, highlighting a new role for regulatory gene HCG27. Additionally, we found that atherogenic metabolite levels mediate the associations between gene expression and cardiovascular risk. Some of these genes showed stronger associations in immune tissues, providing further evidence of the role of immune cells in increasing cardiovascular risk.ConclusionsThese findings propose new gene targets that could be potential candidates for drug development aimed at lowering the risk of cardiovascular events through the modulation of blood atherogenic metabolite levels.

Mechanism analysis of the impact of regional digital transformation on the employment quality in the perspective of labor force structure

Regional digital transformation has revitalized economic development and revolutionized the employment landscape of the labor force. The study employs a dynamic panel system GMM model to investigate the direct and indirect effects of regional digital transformation on the employment quality of China’s labor force using panel data from 31 mainland provinces. The findings suggest that regional digital transformation initially has a negative impact on employment quality, but that it continues to improve continuously as it progresses, showing a “U-shaped” trend. A nonlinear mediation analysis across industry, sector, and skill levels of the labor force structure uncovers a complex, bridging effect on employment quality. This study provides valuable insights for improving employment policies and promoting full employment, highlighting the dynamic interplay between regional digitization and the labor market.

Communion supports dignity for older adults with serious cancer: Quantitative findings from dignity therapy intervention.

Patient dignity is a key concern during end-of-life care. Dignity Therapy is a person-centered intervention that has been found to support patient dignity interviews focused on narrating patients' life stories and legacies. However, mechanisms that may affect utility of the Dignity Therapy have been little studied. In this study, we evaluate whether the extent to which patients are more communal in their interviews acts as a mechanism for increased patient dignity. We analyzed the written transcripts from Dignity Therapy interviews with 203 patients with cancer over the age of 55 receiving outpatient palliative care (M = 65.80 years; SD = 7.45 years, Range = 55-88 years; 66% women). Interviews followed core questions asking patients about their life story and legacy. We used content-coding to evaluate the level of communion narrated in each interview, and mediation analyses to determine whether communion affected dignity impact. Mediation analyses indicated that the extent to which patients narrated communion in their interview had a significant direct effect on post-test Dignity Impact. Communion partially mediated the effect of pre-test on post-test Dignity Impact. For both the life story and legacy segments of the session, narrating communion had a direct effect on post-test Dignity Impact. Narrating communion serves as a mechanism for enhancing patient dignity during Dignity Therapy. Providers may consider explicitly guiding patients to engage in, elaborate on, communal narration to enhance therapeutic utility. In addition, encouraging patients with advanced illness to positively reflect on relationships in life may improve patient dignity outcomes in palliative and end-of-life care.

Punishment and Reward Sensitivity in Risk-Taking as Potential Mechanisms Explaining the Relationships Between Childhood Callous-Unemotional Traits and Adolescent Substance Use in a Longitudinal Cohort Study Sample.

Childhood callous-unemotional (CU) traits are associated with a neurocognitive response style of high reward and low punishment sensitivity, which may make these children particularly vulnerable to substance misuse. However, the mechanisms explaining the link between CU traits and substance use are poorly understood. This study investigated the mediating influences of reward and punishment sensitivity on the association between childhood CU traits and adolescent substance use. Using data from the UK Millennium Cohort Study, mediation analyses were conducted to investigate the potential indirect effects of age 14 reward and punishment sensitivity in risk-taking on the relationships between age 11 CU traits and alcohol, cannabis, and other illicit drug use at age 17. No direct effects of CU traits on substance use were found when accounting for gender, baseline alcohol use, poverty, emotional symptoms, conduct problems, hyperactivity, and verbal ability at age 11. Indirect effects of increased reward sensitivity on the relationship between CU traits and increased use were seen for alcohol, cannabis, and other drugs. There was a significant indirect effect of reduced punishment sensitivity on the relationship between CU traits and increased alcohol use, but not cannabis or other substance use. Findings suggest that reward and punishment sensitivity may have independent effects on decision-making processes contributing to adolescent substance use. Prevention and early intervention for substance use should consider modifying intervention strategies to fit the needs of adolescents with a callous interpersonal style and a neurocognitive profile characterized by a high drive for rewards and low risk aversion.

Mediation analysis of brain magnetic resonance imaging variables with all-cause and cardiovascular disease-specific mortalities in persons with type 2 diabetes.

Glucose variation (GV) has emerged as a predictor of morbidity and mortality in persons with diabetes. However, no study has examined whether brain magnetic resonance imaging (MRI) variables mediated the association between mortality and GV. This study was a retrospective cohort comprising 3,961 individuals with type 2 diabetes (T2D), whose electronic medical records were retrieved from a medical center between January 2001 and October 2021. GV was quantified using coefficient of variation of fasting plasma glucose (FPG-CV) and glycated hemoglobin (HbA1c). The MRI variables included the presence or absence of cerebrovascular abnormality and white matter hyperintensity (WMH). All deaths and deaths resulting from expanded cardiovascular disease (CVD) were identified through annual record linkage with National Death Datasets. Cox proportional hazards models were applied to evaluate associations of MRI variable or GV with mortality. Mediation analyses were performed to assess the relative contributions of MRI variables for GV on mortality. Among 3,961 patients, 2,114 patients (53.4%) had cerebrovascular abnormality and 1,888 patients (47.7%) had WMH. The results showed cerebrovascular abnormality and WMHs were significantly associated with all-cause and expanded CVD mortality after considering GV. The largest mediated effects of GV on all-cause and expanded CVD mortality were observed by cerebrovascular abnormality (5.26% and 8.49%, respectively). Our study suggests cerebrovascular abnormality and WMHs are important predictors of mortality in patients with T2D after considering GV. In addition, MRI variables of cerebrovascular abnormality expressed weak but significant mediation effect on the associations between GV and mortality.

Impact of diabetes mellitus on right ventricular dysfunction and ventricular interdependence in hypertensive patients with heart failure with reduced ejection fraction assessed via 3.0 T cardiac MRI

BackgroundHypertension (HTN) and diabetes mellitus (DM) are two common comorbidities of heart failure with reduced ejection fraction (HFrEF), each of which can cause right ventricular (RV) dysfunction. The aim of this study was to investigate the impact of DM on RV dysfunction and ventricular interdependence in hypertensive HFrEF patients via cardiac magnetic resonance imaging (MRI) feature tracking.MethodsThis study included 249 patients with HFrEF: 77 HFrEF controls, 97 with hypertensive HFrEF (HTN-HFrEF [DM-]) and 75 with hypertensive HFrEF and comorbid DM (HTN-HFrEF [DM+]). The cardiac MRI-derived biventricular global radial (GRS), circumferential (GCS) and longitudinal (GLS) peak strains were obtained and compared among the groups. Multivariable linear regression and mediation analyses were used to evaluate the effects of DM and left ventricular (LV) strain on RV strain.ResultsThe biventricular GLS and GLS of segments 8, 9 and 14 of the interventricular septum (IVS) decreased gradually from the HFrEF control group to the HTN-HFrEF (DM−) group to the HTN-HFrEF (DM+) group (all P < 0.05). Patients with DM had even lower biventricular GCS and IVS strains in all directions in specific segments than did those without DM and the HFrEF controls (all P < 0.05). DM was independently associated with impaired RVGLS and RVGCS (both P < 0.05) in hypertensive HFrEF patients. The difference in RVGLS between the hypertensive HFrEF subgroups was partly mediated by LVGLS [β = 0.80, 95% CI (0.39–1.31)], and that of RVGCS was partly mediated by LVGCS [β = 0.28, 95% CI (0.01–0.62)].ConclusionsIn hypertensive HFrEF patients, comorbid DM may have aggravated RV dysfunction and was an independent determinant of impaired RV strain. RV dysfunction might be directly affected by DM and partially mediated by LV strain through unfavorable ventricular independence.

Unhealthy plant-based diet is associated with a higher cardiovascular disease risk in patients with prediabetes and diabetes: a large-scale population-based study

BackgroundThe role of plant-based dietary patterns in preventing cardiovascular disease (CVD) among individuals with prediabetes and diabetes remains unclear. We aimed to evaluate the associations of plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) with cardiovascular disease (CVD) risk and explore potential contributing factors among people with prediabetes and diabetes.MethodsA total of 17,926 participants with prediabetes and 7798 with diabetes were enrolled from the UK Biobank between 2006 and 2010 and followed until the end of 2020. We calculated the PDI, hPDI, and uPDI based on 18 major food groups including plant-based foods and animal-based foods and applied Cox proportional hazard models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD risk related to PDI, hPDI, and uPDI. Decomposition analysis was performed to assess the role of dietary components, and mediation analysis was performed to assess the potential mediating role of serum biomarkers underlying these associations.ResultsA total of 2324 CVD events were documented among individuals with prediabetes, while 1461 events occurred among patients with diabetes. An inverse association was found between hPDI and CVD risk among individuals with prediabetes (HR T3 vs. T1 = 0.88, 95% CI = 0.79–0.98, Ptrend = 0.025) but not those with diabetes. A positive association was found between uPDI and CVD risk among individuals with prediabetes (HR T3 vs. T1 = 1.17, 95% CI = 1.05–1.30, Ptrend = 0.005) and those with diabetes (HR T3 vs. T1 = 1.14, 95% CI = 1.00–1.29, Ptrend = 0.043). High-sugar-sweetened beverages (SSB) intake accounted for 35% of the hPDI-CVD association and 15% of the uPDI-CVD association among individuals with prediabetes, whereas low intake of whole grain accounted for 36% of the association among patients with diabetes. Elevated cystatin C levels explained the largest proportion of the association between uPDI and CVD risk among individuals with prediabetes (15%, 95% CI = 7–30%) and diabetes (44%, 95% CI = 9–86%).ConclusionsAdherence to an unhealthy plant-based diet is associated with a higher CVD risk in people with prediabetes or diabetes, which may be partially attributed to low consumption of whole grains, high intake of SSB, and high blood cystatin C levels.

Exploring Consumer Participation in Brand Metaverse Communities, Focusing on the Metaverse Features—Fantasy Experiences and Self‐Expansion

ABSTRACTIn light of brands entering the metaverse, understanding consumer behavior in these virtual spaces becomes crucial. This study aims to explore how consumers' intentions to engage in building brand communities within the metaverse are influenced by their fantasy experiences in the brands' virtual stores where consumers are immersed in sensory‐rich, imaginative digital environments. By applying self‐expansion theory to brand–consumer relationships and the concept of temporarily expanding the boundary of the self through consumer metaverse experiences, this research examines the mediating role of self‐expansion in the relationship between fantasy experiences and brand community intentions. A total of 196 responses were collected among Zepeto users through consumer panels. Data were analyzed using AMOS 23.0 for confirmatory factor analysis and the Process macro in SPSS 23.0 for mediation and moderation analysis. Findings reveal direct positive effects of fantasy experiences on consumers' intentions to participate in metaverse brand communities. Users deeply engaged in the metaverse's fantasy experience could expand the sense of self, fostering active contributions to brand community activities. The study also investigates the influences of prior experiential activities in the metaverse, showing that prior engagement enhances the effects of fantasy experiences on self‐expansion. Among users with prior metaverse experiential activities, fantasy experiences exert more significant influences on self‐expansion, driving higher intentions to participate in brand communities.

Association between healthy lifestyle on life course and multimorbidity in adults: results from two national prospective cohort studies

ObjectivesTo examine the correlation between healthy lifestyle patterns, their change trajectories, and the risk of multimorbidity in adults.MethodsBased on two representative national cohorts, the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) including adults aged 50 years and over. We employed Cox regression, lifestyle change trajectories, and restricted mean survival times to explore the relationship between lifestyle (assessed by SCORE2, LE’8, and HLS scores) and multimorbidity. We also conducted mediation analysis to investigate the underlying mechanisms.ResultsA healthy lifestyle (higher LE’8, higher HLS, or lower SCORE2) can reduce the risk of multimorbidity. 2-10% lower multimorbidity risk per one-point increase in LE’8 and HLS. The hazard ratio of multimorbidity for improvements in unhealthy lifestyles or deterioration in healthy lifestyles compared to always healthy lifestyles ranged from 1.598 to 5.602. Besides, for LE’8 and HLS, participants with higher scores had a slower decrease in survival probability in ELSA. Triglyceride, C-reaction protein, fibrinogen, and cystatin C partly mediate the association between lifestyle and multimorbidity.ConclusionsKeeping a healthy lifestyle over time can help reduce the risk of multimorbidity.

The effects of the intrapersonal intelligence of childcare teachers on respect for children’s rights: mediating effects of positive psychological capital and psychological burnout

The purpose of this study is to examine the mediating effects of positive psychological capital and psychological burnout in the relationship between intrapersonal intelligence and respect for children’s rights among childcare teachers. This study explores the psychological mechanisms of childcare teachers that help to strengthen children’s rights in childcare centers. A survey of childcare teachers was conducted in Gyeonggi-do Province in Korea. Out of 560 copies of the questionnaire that were distributed, 502 were returned, and 465 were used for the analysis after questionnaires with incomplete responses were excluded. The collected data were analyzed using PROCESS macro version 4.0 to examine whether positive psychological capital and psychological burnout mediated the relationship between intrapersonal intelligence and respect for children’s rights. The results of this study showed close relationships among all variables. The mediation analysis showed that positive psychological capital and psychological burnout had sequential mediating effects in the relationship between intrapersonal intelligence and respect for children’s rights. Childcare teachers first must increase their positive psychological capital to protect and respect children’s rights. Also, educational programs tailored for childcare teachers must be developed for better psychological well-being to promote respect for children’s rights in the classroom.

The Relationship Between Acculturative Stress, Integration Strategy, Parenting Self-Efficacy, and Multicultural Youth's Perceived Parental Support in South Korea

Over the past decades, ethnically and racially diverse populations have constantly increased in South Korea. In their acculturation, a number of multicultural families encounter acculturative stress, which can negatively influence their individual as well as relational well-being. Therefore, the present study aimed to investigate the association between acculturative stress of multicultural parents ( n = 2,249) and parental support perceived by multicultural youth ( n = 2,271) in South Korea. Additionally, the authors examined the potential mediating effect of parental self-efficacy moderated by parental acculturation on the association between parental acculturative stress and perceived parental support. Moderated mediation analysis was conducted to test the association between multicultural mothers’ acculturative stress and their youth's perceived level of parental support with the mediating effect of multicultural mothers’ parenting self-efficacy level moderated by integration strategy. The moderation analysis identified a significant buffering effect of achieving an integrated level of acculturation on multicultural parents’ acculturative stress and parenting self-efficacy. In addition, parenting self-efficacy significantly mediated the link between multicultural parents’ acculturative stress and multicultural youth's perceived level of parental support. Implications and future directions for mental health professionals, educators, and researchers were discussed.