Mediation Effect Research Articles

Association between being large for gestational age and cardiovascular metabolic health in children conceived from assisted reproductive technology: a prospective cohort study.

To the best of our knowledge, no study has investigated the potential joint effect of large for gestational age (LGA) and assisted reproductive technology (ART) on the long-term health of children. This was a prospective cohort study that recruited children whose parents had received ART treatment in the Center for Reproductive Medicine, Shandong Provincial Hospital, affiliated to Shandong University, between January 2006 and December 2017. Linear mixed model was used to compare the main outcomes. The mediation model was used to evaluate the intermediary effect of body mass index (BMI). 4138 (29.5%) children born LGA and 9910 (70.5%) children born appropriate for gestational age (AGA) were included in the present study. The offspring ranged from 0.4 to 9.9years. LGAs conceived through ART were shown to have higher BMI, blood pressure, fasting blood glucose, fasting insulin, and homeostatic model assessment of insulin resistance values, even after controlling for all covariates. The odds of overweight and insulin resistance are also higher in LGA subjects. After adjusting for all covariates, LGAs conceived through ART had BMI and BMI z-scores that were 0.48kg/m2 and 0.34 units greater than those of AGAs, respectively. The effect of LGA on BMI was identified as early as infancy and remained consistently significant throughout pre-puberty. Compared to AGA, LGA children conceived from ART were associated with increased cardiovascular-metabolic events, which appeared as early as infancy and with no recovery by pre-puberty.

Association between quality of discharge teaching and self-management in patients after percutaneous coronary intervention: A chain mediation model.

To examine chain mediating effect of discharge readiness and self-efficacy between quality of discharge teaching and self-management in patients after percutaneous coronary intervention (PCI). Although self-management after PCI has significant benefits in controlling risk factors and delaying disease progression, the status of self-management remains unoptimistic. A large number of studies have explored the close relationship between the quality of discharge teaching and patients self-management, but little is known about the underlying mechanisms. The cross-sectional samples was collected from a tertiary hospital in China. Self-reported questionnaires were used to assess quality of discharge teaching, discharge readiness, self-efficacy and self-management. Pearson correlation analysis and mediation effect analysis were used for statistical analysis. The study used the STROBE checklist for reporting. A total of 198 patients with a mean age of 64.99 ± 11.32 (34-85) were included. The mean score of self-management was 88.41 ± 11.82. Quality of discharge teaching, discharge readiness, self-efficacy and self-management were all positively correlated. Mediation effect analysis showed that the mediating effects of discharge readiness, self-efficacy, discharge readiness and self-efficacy between quality of discharge teaching and self-management were 0.157, 0.177 and 0.049, respectively, accounting for 21.96%, 24.76% and 6.85% of the total effect. The quality of discharge teaching for patients after PCI not only directly affects self-management, but also can indirectly affect self-management through discharge readiness and self-efficacy. To improve the life quality of patients after PCI, medical staff should pay attention to the influence of self-management of quality of discharge teaching, and develop intervention strategies based on the path of discharge readiness and self-efficacy. Questionnaires filled out by patients were used to understand the association between quality of discharge teaching, discharge readiness, self-efficacy and self-management.

The mediating role of kynurenine pathway metabolites on the relationship between inflammation and muscle mass in oldest-old men.

Tryptophan (TRP) metabolites along the kynurenine (KYN) pathway (KP) have been found to influence muscle. Pro-inflammatory cytokines are known to stimulate the degradation of TRP down the KP. Given that both inflammation and KP metabolites have been connected with loss of muscle, we assessed the potential mediating role of KP metabolites on inflammation and muscle mass in older men. 505 men (85.0±4.2yrs) from the Osteoporotic Fractures in Men cohort study with measured D3-creatine dilution (D3Cr) muscle mass, KP metabolites, and inflammation markers (C-reactive protein (CRP), alpha-1-acid glycoprotein (AGP) and a subsample (n=305) with interleukin (IL-6, IL-1β, IL-17A) and tumor necrosis factor-α (TNF-α)) were included in the analysis. KP metabolites and inflammatory markers were measured using liquid chromatography-tandem mass spectrometry and immunoassays, respectively. 23-92% of the inverse relationship between inflammatory markers and D3Cr muscle mass was mediated by KP metabolites (indirect effect p<0.05). 3-hydroxyanthranilic acid (3-HAA), quinolinic acid (QA), TRP, xanthurenic acid (XA), KYN/TRP, 3-hydroxykynurenine (3-HK)/3-HAA, QA/3-HAA, and nicotinamide (NAM)/QA mediated the AGP relationship. 3-HAA, QA, KYN/TRP, 3-HK/XA, HKr ratio, 3-HK/3-HAA, QA/3-HAA, and NAM/QA mediated the CRP. KYN/TRP, 3-HK/XA, and NAM/QA explained the relationship for IL-6 and 3-HK/XA and QA/3-HAA for TNF-α. No mediation effect was observed for the other cytokines (indirect effect p>0.05). KP metabolites, particularly higher ratios of KYN/TRP, 3-HK/XA, 3-HK/3-HAA, QA/3-HAA and a lower ratio of NAM/QA, mediated the relationship between inflammation and low muscle mass. Our preliminary cross-sectional data suggest that interventions to alter D3Cr muscle mass may focus on KP metabolites rather than inflammation per se.

Associations of Long-Term Exposure to Fine Particulate Constituents With Cardiovascular Diseases and Underlying Metabolic Mediations: A Prospective Population-Based Cohort in Southwest China.

The health effects of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) might differ depending on compositional variations. Little is known about the joint effect of PM2.5 constituents on metabolic syndrome and cardiovascular disease (CVD). This study aims to evaluate the combined associations of PM2.5 components with CVD, identify the most detrimental constituent, and further quantify the mediation effect of metabolic syndrome. A total of 14 427 adults were included in a cohort study in Sichuan, China, and were followed to obtain the diagnosis of CVD until 2021. Metabolic syndrome was defined by the simultaneous occurrence of multiple metabolic disorders measured at baseline. The concentrations of PM2.5 chemical constituents within a 1-km2 grid were derived based on satellite- and ground-based detection methods. Cox proportional hazard models showed that black carbon, organic matter (OM), nitrate, ammonium, chloride, and sulfate were positively associated with CVD risks, with hazard ratios (HRs) ranging from 1.24 to 2.11 (all P<0.05). Quantile g-computation showed positive associations with 4 types of CVD risks (HRs ranging from 1.48 to 2.25, all P<0.05). OM and chloride had maximum weights for CVD risks. Causal mediation analysis showed that the positive association of OM with total CVD was mediated by metabolic syndrome, with a mediation proportion of 1.3% (all P<0.05). Long-term exposure to PM2.5 chemical constituents is positively associated with CVD risks. OM and chloride appear to play the most responsible role in the positive associations between PM2.5 and CVD. OM is probably associated with CVD through metabolic-related pathways.

Temporal relationship between hepatic steatosis and blood pressure elevation and the mediation effect in the development of cardiovascular disease.

The temporal relationship between non-alcoholic fatty liver disease (NAFLD) and hypertension remains highly controversial, with ongoing debates on whether NAFLD induces hypertension or vice versa. We employed cross-lagged panel models to investigate the temporal relationship between hepatic steatosis (assessed by Fatty Liver Index [FLI] in the main analysis, and by Proton Density Fat Fraction [PDFF] in the validation study) and blood pressure (systolic and diastolic blood pressure [SBP/ DBP]). Subsequently, we employed causal mediation models to explore the mediation effect in CVD development, including ischemic heart disease and stroke. The main analysis incorporated repeated measurement data of 5,047 participants from the China Multi-Ethnic Cohort (CMEC) and 5,685 participants from the UK Biobank (UKB). In both cohorts, the path coefficients from FLI to blood pressure were significant and greater than the path from blood pressure to FLI, with βFLI→SBP = 0.081, P < 0.001 versus βSBP→FLI = 0.020, P = 0.031; βFLI→DBP = 0.082, P < 0.001 versus βDBP→FLI = -0.006, P = 0.480 for CEMC, and βFLI→SBP = 0.057, P < 0.001 versus βSBP→FLI = -0.001, P = 0.727; βFLI→DBP = 0.061, P < 0.001, versus βDBP→FLI = -0.006, P = 0.263 for UKB. The validation study with 962 UKB participants using PDFF consistently supported these findings. In the mediation analyses encompassing 11,108 UKB participants, SBP and DBP mediated 12.2% and 5.2% of the hepatic steatosis-CVD association, respectively. The proportions were lower for ischemic heart disease (SBP: 6.1%, DBP: non-statistically significant -6.8%), and relatively stronger for stroke (SBP: 19.4%, DBP: 26.1%). In conclusion, hepatic steatosis more strongly contributes to elevated blood pressure than vice versa. Blood pressure elevation positively mediates the hepatic steatosis-CVD association, particularly in stroke compared to ischemic heart disease.

The relationships between recovery and teachers' exhaustion and performance: Mediational role of work-related self-efficacy

The aim of the study was to better understand the process through which recovery leads to teachers' exhaustion and performance. The direct and the indirect, i.e., mediated by teacher' work-related self-efficacy, effects of recovery on exhaustion and job performance were measured. To assessment of recovery, the Polish version of the Work-Related Rumination Scale (W-RRS) was developed. It measures detachment, affective rumination and problem-solving pondering. The psychometric properties of this tool constitute an additional contribution to the article. The study was conducted among a group of primary and secondary school teachers (N = 503). The factor structure of the W-RRS scale was checked using confirmatory factor analysis (CFA), its reliability by using of Cronbach's α measure, and its theoretical validity by means of correlation of main variables with criterion variables. Hypotheses related to direct and mediation effects were verified using structural equation modeling (SEM). The obtained results confirmed the criterion and construct validity and reliability of the W-RRS. It has been also shown that detachment is directly negatively associated with exhaustion (but not with performance), affective rumination is a predictor of higher exhaustion and lower job performance, and problem-solving pondering is related to job performance (but not to exhaustion). Self-efficacy mediates the effect of 2 (out of the 3) types of recovery on exhaustion and job performance, such that high levels of problem-solving pondering and low levels of affective rumination translate into high self-efficacy, which in turn leads to lower exhaustion and higher job performance. The recovery methods have various implications for functioning of teachers. While detachment and problem-solving pondering seem to promote it, affective rumination intensifies exhaustion and reduces performance. The mediator of the recovery-psychological well-being relationship is self-efficacy. The W-RRS questionnaire can be used to assessment of rumination among teachers.

Is academic innovation need of an hour? The role of intellectual capital and dynamic capabilities in driving academic performance

Purpose This study aims to explore the connections between intellectual capital and academic performance in Lahore, Pakistan’s higher education institutions (HEIs). The research delves into the mediation effect of dynamic capabilities, such as acquisition and exploitation, between intellectual capital and innovation within these educational institutions. Design/methodology/approach Grounded in the insights from a comprehensive literature review, the methodology uses a pre-tested questionnaire. Faculty members from private universities in Pakistan were chosen as the study's unit of analysis. Using a convenience sampling technique, data was gathered from 342 teachers and then analyzed using Smart (PLS) 3.3.3. Findings The results demonstrate that intellectual capital positively affects innovation. Acquisition and exploitation further mediate this influence, improving academic performance. Applying the knowledge-based view theory, the study confirmed the significance of all the posited hypotheses, underlining the positive interrelationships within Pakistan’s academic institutions. Originality/value The novelty of this research lies in its specific focus on the HEIs in Pakistan, demonstrating how intellectual capital and dynamic capabilities foster innovation, thereby enabling these institutions to maintain a competitive edge in a rapidly evolving educational landscape.

Impact of Collaborative Leadership, Workplace Social Capital, and Interprofessional Collaboration Practice on Patient Safety Climate.

Patient safety climate is an important factor in promoting patient safety for healthcare organizations. This study investigated the relationship between collaborative leadership and patient safety climate, the mediation effect of workplace social capital, or interprofessional collaboration practice. A web-based cross-sectional questionnaire survey was administered between May 2021 and May 2022, to employees of three acute care hospitals in Japan. The relationship between variables was verified by structural equation modeling. A total of 1,276 staff members participated in the study. Collaborative leadership affected the workplace social capital (β = .734) and interprofessional collaboration (β = .561), which were positively associated with patient safety climate (β = .403 and .405, respectively), verifying the mediating relationship of workplace social capital and interprofessional collaboration between collaborative leadership and patient safety climate. Collaborative leadership enhances the reciprocity and interprofessional practices of the healthcare team. The interaction among interprofessional team members fosters a patient safety climate. The results of this survey suggest that the development of collaborative leadership, which encourages interprofessional collaboration and fosters workplace social capital, is inherently crucial for cultivating a patient safety climate.

Digital economy and regional innovation: unveiling the spatial dynamics and human capital influence in China

Purpose The paper aims to examine the digital economy's influence on China's regional innovation and development. It focuses on direct effects and spatial spillover across regions, and the mediating role of human capital. This analysis is vital for policy and strategic planning in the digital era. Design/methodology/approach This study uses panel data from 30 Chinese provinces (2004–2019) and uses the entropy method to quantify the digital economy's development. It investigates its impact on regional innovation using a dynamic spatial Durbin model (SDM) and mediation effect model, assessing direct effects, spatial spillover and human capital's mediating role. Various control variables are included for comprehensive analysis. Findings Findings show the digital economy significantly boosts regional innovation, acting as a growth driver. However, impacts vary regionally, with the central region gaining more than the eastern and western areas. Spatial spillover effects are mixed, showing negative short-term and positive long-term impacts under different weight matrices. Human capital is crucial for fostering innovation through the digital economy. Originality/value The paper offers unique insights into the spatial dynamics of the digital economy's impact on regional innovation in China. It advances understanding of the digital economy's role in regional development using innovative methods like the entropy method and dynamic SDM. Highlighting human capital as a key mediating factor enriches discussions on digital economy strategies for regional innovation.

The role of peripheral white blood cell counts in the association between central adiposity and glycemic status.

Although central adiposity is a well-known risk factor for diabetes, the underlying mechanism remains unclear. The aim of this study was to explore the potential mediation role of circulating WBC counts in the association between central adiposity and the risk of diabetes. A cross-sectional study was conducted using data from the Fuqing cohort study, which included 6,613 participants aged 35-75 years. Logistic regression analysis and Spearman's rank correlation analysis were used to examine the relationships between waist-to-hip ratio, WBC counts and glycemic status. Both simple and parallel multiple mediation models were used to explore the potential mediation effects of WBCs on the association of waist-to-hip ratio with diabetes. The study revealed a positive relationship between waist-to-hip ratio and risk of prediabetes (OR = 1.53; 95% CI, 1.35 to 1.74) and diabetes (OR = 2.89; 95% CI, 2.45 to 3.40). Moreover, elevated peripheral WBC counts were associated with both central adiposity and worsening glycemic status (P < 0.05). The mediation analysis with single mediators demonstrated that there is a significant indirect effect of central adiposity on prediabetes risk through total WBC count, neutrophil count, lymphocyte count, and monocyte count; the proportions mediated were 9.92%, 6.98%, 6.07%, and 3.84%, respectively. Additionally, total WBC count, neutrophil count, lymphocyte count, monocyte count and basophil count mediated 11.79%, 11.51%, 6.29%, 4.78%, and 1.76%, respectively, of the association between central adiposity and diabetes. In the parallel multiple mediation model using all five types of WBC as mediators simultaneously, a significant indirect effect (OR = 1.09; 95% CI, 1.06 to 1.14) were observed, with a mediated proportion of 12.77%. Central adiposity was independently associated with an elevated risk of diabetes in a Chinese adult population; levels of circulating WBC may contribute to its underlying mechanisms.

EHealth mindfulness-based music therapy for patients undergoing allogeneic hematopoietic stem cell transplantation: A pilot randomized controlled trial protocol.

Allogeneic stem cell transplantation (allo-SCT) is the preferred therapy for patients with high-risk or relapsed hematologic malignancies, but may be complicated by psychological distress (e.g., depression, anxiety) and symptom burden (e.g., fatigue, pain). Mindfulness-based music therapy (MBMT), a relatively novel integrative medicine intervention that draws from mindfulness and music therapy principles, has shown promise in improving psychosocial outcomes and symptom burden in cancer patients. We outline an eHealth-based MBMT (eMBMT) intervention protocol examining: (1) feasibility, acceptability, and intended effects of eMBMT in improving HRQOL, symptom burden, and clinical markers of disease activity (e.g., infections), and (2) the extent to which eMBMT music therapy component-associated improvements in HRQOL, symptom burden, and disease activity are mediated by improvements in psychosocial and physiological (e.g., systemic inflammation, immune recovery) adaptation. Participants (n = 60) with a hematologic malignancy undergoing allo-SCT will be randomized to receive eMBMT or an eHealth-based mindfulness meditation (eMM) intervention. eMBMT includes eight 60-min sessions facilitated by a music therapist focusing on mindfulness and music therapy. eMM includes eight 60-min self-led MM practices. Feasibility, acceptability, HRQOL, symptom burden, disease activity, and mediation effects of psychosocial and physiological adaptation will be assessed at baseline, pre-infusion, and post-engraftment with blood collection at baseline and post-engraftment. The current pilot RCT is the first eMBMT intervention to address the HRQOL and symptom burden of patients who are undergoing allo-SCT. Results will inform a fully powered RCT to establish preliminary efficacy of eMBMT on improvements in HRQOL, symptom burden, and disease activity.

Research into the impact of an imbalanced teaching-academic research evaluation system on the quality of higher education: based on the mediation effect of the sense of belonging to a university

Research into the impact of an imbalanced teaching-academic research evaluation system on the quality of higher education: based on the mediation effect of the sense of belonging to a university

Cardiorespiratory fitness attenuates the association between fatness and cardiometabolic risk in Chinese children

BackgroundChildhood obesity tends to persist into adulthood, predisposing individuals to cardiometabolic risk (CMR). This study aims to investigate the mediating role of cardiorespiratory fitness (CRF) in the associations between multiple fatness indicators and individual CMR markers and clustered CMR-score, and explore sex differences.MethodsWe recruited 1,557 children (age: 8 to 10, male/female: 52.7%/47.3%) in September 2022 in Ningbo, China. Physical examinations, overnight fasting blood test, and CRF was evaluated. The CMR-score was calculated by summing age- and sex-specific z scores of four CMR markers, including mean arterial blood pressure, triglycerides, the total cholesterol to high-density lipoprotein cholesterol ratio, and homeostatic model assessment for insulin resistance. Generalized linear mixed models were used to identify the associations, mediation analyses were performed to dissect the function of CRF.ResultsPartial correlation analyses revealed positive associations between high fatness indicators (including body mass index [BMI], BMI z score, body fat mass index [BFMI] and waist-to-height ratio [WHtR]) and increased CMR markers, whereas high CRF was associated with decreased CMR markers (all P &amp;lt; 0.05). In the mediation analyses, CRF emerged as a partial mediator, attenuating the relationship between four fatness indicators and CMR-score. Specifically, CRF mediated 6.5%, 7.7%, 5.3%, and 12.5% of the association between BMI, BMI z score, BFMI, WHtR and CMR-score (all P &amp;lt; 0.001). And the mediating effects of CRF between WHtR and four individual CMR markers was particularly robust, ranging from 10.4% to 21.1% (all P &amp;lt; 0.05). What’s more, CRF mediates the associations between WHtR and CMR-score more pronounced in girls than boys with a mediation effect size of 17.3% (P &amp;lt; 0.001).ConclusionIn Chinese children, CRF partially mitigates the adverse effects of fatness on CMR, underscoring the significance of enhancing CRF in children.

대학생의 우울과 자존감의 관계에서 자기격려-낙담의 병렬다중매개효과

Objectives The purpose of this study was to verify the parallel multiple mediating effects of cognitive-emo-tion-behavior, which were sub-factors of self-encouragement and self-discouragement, in the relationship be-tween depression and self-esteem in college students. Methods A survey was conducted on college students who voluntarily participated online, and all surveys were set as mandatory responses so that there was no unanswered response. The collected data were subjected to re-liability analysis, descriptive statistics of variables, and correlation analysis using the SPSS 26.0 statistical pro-gram, and the parallel multiple mediation model was verified using PROCESS Macro Model 4. Results First, college students' depression was negatively correlated with self-esteem and self-encouragement, and positively correlated with self-discouragement, and self-esteem was positively correlated with self-encour-agement and negatively correlated with self-discouragement. Second, in the relationship between depression and self-esteem in college students, the mediating effect of self-encouragement-cognition and self-encour-agement-emotion was significant, while the mediating effect of self-encouragement-behavior was not significant. The explanatory power of the model was 43.7%. Third, in the relationship between depression and self-esteem in college students, the mediating effects of self-discouragement-cognition and self-discourage-ment-behavior were significant, while the mediation effect of self-discouragement-emotion was not significant. The explanatory power of the model was 66.1%. Conclusions Through the results of this study, we confirmed the importance of cognition in improving self-es-teem and preventing decline in self-esteem in depressed college students, and confirmed that the factors that need to be intervened in self-encouragement and self-discouragement are different. In addition, rather than fo-cusing on self-encouragement, it was verified that there was a need to help prevent depressive symptoms from accelerating due to a decline in self-esteem. This study is significant in that it provided empirical evidence for con-structing an intervention program to improve the self-esteem of depressed college students.

The role of psychological distress in the relationship of financial strain with oral health and dental attendance in Dutch adults: A mediation analysis based on cross-sectional data.

The study aimed to assess whether psychological distress mediates the association between financial strain and oral health and dental attendance in the Dutch adult population. The study followed a cross-sectional design based on 2812 participants from the 2014 wave of the Dutch population-based GLOBE study. Financial strain was considered the exposure, while psychological distress measured with the Mental Health Inventory-5 (MHI-5) was the mediator. The outcomes included self-reported number of teeth, self-rated oral health, and self-reported dental attendance. Generalized regression analyses were used for the mediation analysis adjusted for several covariables. Greater financial strain was significantly associated with poorer self-rated oral health (total effect: 0.09, 95%CI: 0.05; 0.14) and restorative or no dental attendance (i.e. participants never visiting a dentist or only visiting a dentist for regular treatments or when they have complaints with their mouth, teeth, or prosthesis) (total effect: 0.05, 95%CI: 0.02; 0.09). Greater financial strain was not significantly associated with self-reported number of teeth (total effect: -0.14, 95%CI: -0.91; 0.64). Psychological distress significantly mediated the association of financial strain with self-rated oral health (average causal mediation effect [ACME]: 0.02, 95%CI: 0.01; 0.03) and self-reported dental attendance (ACME: 0.01, 95%CI: 0.00; 0.02), respectively. However, it did not significantly mediate the association of financial strain with self-reported number of teeth (ACME: -0.11, 95%CI: -0.25; 0.02). The estimated proportion of the total effect of financial strain on self-rated oral health and self-reported dental attendance that could be explained by psychological distress was respectively 24% (95%CI: 14%; 48%) and 19% (95%CI: 6%; 62%). Psychological distress partly explains the association of financial strain with self-rated oral health and dental attendance, but not with self-reported number of teeth. Future studies using longitudinal data are necessary to confirm the results.

Examining the socio-psychological dynamics of interpersonal and organizational deviances: the moderating influence of interpersonal justice and perceived organizational support

Examining the socio-psychological dynamics of interpersonal and organizational deviances: the moderating influence of interpersonal justice and perceived organizational support

The Impact of Organizational Change on Organizational Commitment and The Mediation Effect of Job Security, Trust and Justice in Pharmaceutical Industry in Indonesia

This research aims to determine the impact of organizational change on organizational commitment and the mediating effect of Job Security, Trust and Justice in pharmaceutical industry in Indonesia. Research was conducted among employees from four (4) different pharmaceutical companies in Jakarta, Indonesia. The sampling technique is based on probability sampling and data collection method used in this research was using questionnaire with total sampel obtained was 108. The research design used is descriptive quantitative research. The data analysis technique uses structural equation modeling-partial least square. The result showed that organizational change has insignificant direct positive impact on organizational commitment, Job Security does not mediate the impact of organizational change to organizational commitment, organizational change has indirect significant impact on organizational commitment through mediator variables Trust and Justice. Trust and Justice fully mediate the effect of organizational change to organizational commitment. Based on the result of the study, it was suggested that pharmaceutical companies to put more emphasis on trust &amp; justice and achieve higher level of trust and justice during organizational change process to increase employee’s commitment.

Does pain self-efficacy predict, moderate or mediate outcomes in people with chronic headache; an exploratory analysis of the CHESS trial

BackgroundChronic headache disorders are disabling. The CHESS trial studied the effects of a short non-pharmacological intervention of education with self-management support for people affected by migraine and/or tension type headache for at least 15 days per month for at least three months. There were no statistically significant effects on the Headache Impact Test-6 (HIT-6) at 12-months. However, we observed improvement in pain self-efficacy questionnaire (PSEQ) and short-term HIT-6. We explored the impact of the CHESS intervention on PSEQ, and subsequently, on the HIT-6 and chronic headache quality of life questionnaire (CH-QLQ) at four, eighth and 12 months.MethodsWe included all 736 participants from the CHESS trial. We used simple linear regression models to explore the change of HIT-6 and CH-QLQ with treatment and PSEQ at baseline (predictor analysis), and the interaction between treatment and baseline PSEQ (moderator analysis). We considered the change of PSEQ from baseline to four months as a mediator in the mediation analysis.ResultsBaseline PSEQ neither predicted nor moderated outcomes. The prediction effect on change of HIT-6 from baseline to 12 months was 0.01 (95% CI, -0.03 to 0.04) and the interaction (moderation) effect was −0.07 (95% CI, -0.15 to 0.002). However, the change of PSEQ from baseline to 4-month mediated the HIT-6 (baseline to 8-, and 12-month) and all components of CH-QLQ (baseline to 8-, and 12-month). The CHESS intervention improved the mediated variable, PSEQ, by 2.34 (95% CI, 0.484 to 4.187) units and this corresponds to an increase of 0.21 (95% CI, 0.03 to 0.45) units in HIT-6 at 12-months. The largest mediated effect was observed on the CH-QLQ Emotional Function, an increase of 1.12 (95% CI, 0.22 to 2.20).ConclusionsPSEQ was not an effective predictor of outcome. However, change of short-term PSEQ mediated all outcomes, albeit minimally. Future behavioural therapy for chronic headache may need to consider how to achieve larger, and more sustained increases level of self-efficacy than that achieved within the CHESS trial.Trial registrationISRCTN79708100.

Mediation of work-and-family conflict in the relationship between social-and-organizational support and teaching self-efficacy: The case of parent-teachers working remotely

AbstractIn times of crisis (e.g., during the COVID-19 pandemic), teachers face the dual responsibility of caring for their own children, while adapting to remote instruction. This study explores the interplay between social and organizational support, teaching self-efficacy, and the mediating effect of work-family conflict in remote teaching. The participants were 472 teachers who are parents of children aged 0–12. This mixed-methods study revealed that low levels of family-work and work-family conflict were associated with higher levels of social and organizational support, and teaching self-efficacy. A mediation effect revealed that social and organizational support predicted family-work conflict, which in turn predicted teaching self-efficacy. Qualitative findings highlighted the challenges and coping strategies used while working remotely. This research enhances our understanding of the work-family conflict encountered by parent-teachers, with important implications for teacher education. Such understanding facilitates effective management of family-work conflict during remote work, future epidemics, military conflicts, or natural disasters.

Mediation effect of body mass index on the association between serum magnesium level and insulin resistance in children from Mexico City.

Reduced serum magnesium (Mg) levels have been associated with obesity, insulin resistance (IR), type 2 diabetes, and metabolic syndrome in adults. However, in the children population, the evidence is still limited. In this cross-sectional study, we aimed to analyze the association of serum Mg levels with the frequency of overweight and obesity and cardiometabolic traits in 189 schoolchildren (91 girls and 98 boys) between 6 and 12 years old from Mexico City. Anthropometrical data were collected and biochemical parameters were measured by enzymatic colorimetric assay. Serum Mg level was analyzed by inductively coupled plasma mass spectrometry (ICP-MS). The triglyceride-glucose (TyG) index was used as a surrogate marker to evaluate IR. Serum Mg level was negatively associated with overweight (Odds ratio [OR] = 0.377, 95% confidence interval [CI] 0.231-0.614, p < 0.001) and obesity (OR = 0.345, 95% CI 0.202-0.589, p < 0.001). Serum Mg level resulted negatively associated with body mass index (BMI, β = -1.16 ± 0.26, p < 0.001), BMI z-score (β = -0.48 ± 0.10, p < 0.001) and TyG index (β = -0.04 ± 0.04, p = 0.041). Through a mediation analysis was estimated that BMI z-score accounts for 60.5% of the negative association of serum Mg level with IR (Sobel test: z = 2.761; p = 0.005). Our results evidence that BMI z-score mediate part of the negative association of serum Mg level and IR in Mexican schoolchildren.