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.

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

Classification of somatization symptoms based on latent profile analysis: The differential mediating role of psychological capital in organizational commitment.

Plant and bacterial diversity co-regulate ecosystem multifunctionality in subtropical grasslands of southwestern China.

This study examined the Family Check-Up Online (FCU-O), which combines app-based parenting support combined with telehealth coaching, to address parent and youth functioning in the wake of the COVID-19 pandemic. Research since the pandemic has highlighted long-term consequences for parents and youth (including emotional and behavioral difficulties along with long-term learning loss), as well as limitations to available supports. The FCU-O was designed to increase access and reach of such supports in order to promote effective parenting and improvements in youth emotional and behavioral functioning. The current randomized trial examined parent and youth outcomes at baseline, 3-month, and 6-month follow-up assessments among families randomly assigned to the FCU-O (N = 142) or a no-treatment control condition (N = 139). Receipt of FCU-O was associated with significant improvements in parenting skills (greater proactive parenting, limit setting, and warmth, as well as reductions in negative parenting) and perceptions of parenting (including parenting confidence and reduced parenting stress), although the pattern of results was complex with several effects (perceived stress, limit setting, negative parenting, and parenting competence) only observed in post hoc analyses of within-group changes. Significant direct effects of the FCU-O on youth emotional or behavioral problems were not observed, although indirect effects of the FCU-O on youth conduct problems were observed at 6months, via improvements in parents' sense of competence at 3months. Results offer further support for the FCU-O as an accessible intervention for families facing ongoing challenges, including those associated with the COVID-19 pandemic.

This study was conducted to examine the mediating role of eudaimonic well-being in the effect of perceived poverty on quality of life in the elderly. This descriptive cross-sectional study was conducted with 523 elderly individuals aged 65 years and over living in Erzurum province between July and November 2024. R programming language 4.1.3, G*Power 3.1, and SPSS-22 program were used in the analysis of the study. The variable 'Perceived Poverty' has a negative and statistically significant effect on eudaimonic well-being (coefficient = -0.2546, p < 0.001). The variable 'eudaimonic well-being' has a positive and statistically significant direct effect on Quality of Life (coefficient = 0.4366, p < 0.001). The variable 'Perceived Poverty' has a negative and statistically significant direct effect on Quality of Life (coefficient = -0.2580, p < 0.001). The indirect effect measured through the variable 'eudaimonic well-being' was statistically significant (Effect = -0.1111, BootLLCI = -0.1385, BootULCI = -0.0826). According to the Shap graph, Perceived Poverty is identified as the most important variable in predicting the Quality of Life variable. Eudaimonic well-being significantly mediates the negative impact of perceived poverty on elderly quality of life. These findings highlight the need for holistic care programs that combine material support with interventions fostering purpose and personal growth. It is recommended that longitudinal studies be conducted on quality of life among the elderly.

Background: Type 2 Diabetes Mellitus (T2DM) Poses a Global Health Challenge, Requiring Effective Self-Care Management and Active Patient Engagement. Self-Care in Diabetes Management Is a Critical Determinant of Successful Outcomes. This Study Aimed to Predict Diabetes Management Self-Care Based on Intolerance of Uncertainty and Mindfulness, with Perceived Social Support as a Mediator, in Patients with T2DM.Methods: This descriptive-correlational study utilized structural equation modeling (SEM). The statistical population consisted of patients referred to the Yazd Diabetes Association in the first half of 2024. A sample of 350 participants was selected using convenience sampling. Data were collected using the Intolerance of Uncertainty Scale (Carleton et al., 2007), the Mindful Attention Awareness Scale (Brown &amp; Ryan, 2003), the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988), and the Type 2 Diabetes Self-Care Questionnaire (Neamatizadeh et al., 2022). Data analysis was performed using SPSS-24 and AMOS software.Results: The findings revealed that mindfulness had a significant direct (β= 0.343, p&lt; 0.001) and indirect effect, mediated by perceived social support (β= 0.133, p&lt; 0.001), on diabetes management Self-Care. Intolerance of uncertainty had a significant direct and negative effect on Self-Care (β= -0.191, p= 0.025); however, the mediating role of perceived social support in this relationship was not confirmed. The model fit indices (CFI= 0.97, RMSEA= 0.07) indicated a good fit of the proposed model.Conclusion: The results suggest that mindfulness enhances Self-Care in diabetes management both directly and indirectly by boosting perceived social support. Conversely, intolerance of uncertainty acts as a direct barrier to Self-Care. Therefore, developing educational interventions focused on enhancing mindfulness and reducing intolerance of uncertainty could improve Self-Care management and lead to better glycemic control in patients with T2DM.

Hypertension affects over a billion people in the world, despite this prevalence, poor adherence to antihypertensive medication remains the main problem in low-income regions. Social support and resilience might influence adherence to antihypertensive medication.This cross-sectional study investigated the associations among perceived social support, resilience, and antihypertensive medication adherence in hypertensive patients in Izeh County, Iran. This descriptive-analytical cross-sectional study was conducted, from April to December 2024 among adults with hypertension selected through a two-stage cluster sampling method from urban and rural health centers in Izeh County. Of the 600 initially enrolled participants (350 urban, 250 rural), 70 were excluded due to more than two missing items on the MMAS-8 questionnaire, leaving 530 participants for analysis. Data were collected using self-administered validated questionnaires under researcher supervision at urban and rural health centers, including the Morisky Medication Adherence Scale (MMAS-8), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Resilience Questionnaire.No resilience subscales were removed due to intellectual property restrictions, and potential conceptual overlap was statistically controlled. Analyses were conducted using SPSS 24 and AMOS 20, applying regression, path analysis, and structural equation modeling (SEM) to assess direct and indirect pathways. Perceived social support showed a significant positive effect on resilience (β = 0.43, p < 0.001) and an indirect effect on medication adherence (β = 0.10, p < 0.001). Resilience had a significant direct effect on medication adherence (β = 0.19, p = 0.002). The direct effect of social support on medication adherence was not statistically significant (p = 0.070). Among social support dimensions, family support was the strongest (M = 15.82, SD = 2.82). The SEM model demonstrated The model demonstrated an acceptable fit to the observed data (RMSEA = 0.054; CFI = 0.91). These findings bring out the imperative of social support and resilience to medication adherence among hypertensive patients. It is important to strengthen the social networks and psychological resilience to improve adherence to antihypertensive medication and overall disease management,Psychosocial strategies should thus be incorporated into future interventions to improve adherence to antihypertensive medication within resource-limited settings.

ABSTRACT This study examines the effect of school principals’ distributed leadership behaviors on teacher collaboration and investigates the mediating role of teacher agency in this relationship within the Turkish context. Employing a quantitative correlational survey design, the study draws on data from 525 teachers working in public K–12 schools across 12 provinces in Türkiye. The results indicate that distributed leadership has significant and positive direct effects on both teacher agency and teacher collaboration. In addition, teacher agency partially mediates the relationship between distributed leadership and teacher collaboration. Enhancing teacher autonomy and participation strengthens sustainable collaborative professional practices.

The "Internet+Nursing Service" currently being piloted in China has created a new opportunity for home-based enterostomy patients to obtain professional care support. However, whether this service can play a role largely depends on whether patients use it. In this study, we established an integrated model based on the Unified Theory of Acceptance and Use of Technology 2(UTAUT2) with the addition of 2 variables, initial trust and perceived risk, to explore factors that may influence enterostomy patients' intention to use "Internet+Nursing Service". An analysis of survey data from 301 enterostomy patients using structural equation modeling revealed that performance expectancy, social influence, price value and initial trust were significant, positive direct predictors of usage intention. Further cross‑sectional mediation analysis suggested that initial trust partially mediated the relationship between performance expectancy and usage intention and between social influence and usage intention. Furthermore, perceived risk had no significant direct effect on usage intention but had a significant indirect effect through initial trust, suggesting full mediation in our model. This study expands the application scenarios of UTAUT2 in the field of health care consumption, and its empirical findings provide preliminary insights that may inform the implementation and promotion of "Internet+Nursing Service" in similar settings.

This study investigates how information overload influences fear of disease progression among 579 surgical patients at a tertiary hospital in China, specifically examining the independent and serial mediating effects of decisional conflict and generalized anxiety. Using validated scales and a chain mediation model with bias-corrected bootstrapping, the results demonstrate that information overload significantly predicts increased decisional conflict, anxiety, and fear of disease progression. Path analysis confirmed a significant direct effect of information overload on fear, while also identifying three critical indirect trajectories: independent mediation by decisional conflict, independent mediation by anxiety, and a serial pathway from decisional conflict to anxiety. This total indirect effect constituted the majority of the comprehensive impact. The findings indicate that excessive medical information exacerbates fear of disease progression both directly and indirectly by triggering cognitive stressors and escalating emotional responses. These results suggest that optimizing the delivery of health information is essential for reducing decisional conflict and mitigating psychological distress in surgical settings.

This research aims to analyze the influence of Service Quality and Price Fairness on Customer Loyalty through a dual mediation model involving Customer Satisfaction and Customer Trust, while comparing the effectiveness of transactional learning and relational learning pathways in building loyalty within an independent workshop context. A quantitative explanatory cross-sectional design was employed. Data were collected from customers who had visited Bengkel NM at least twice within the preceding eighteen months using purposive sampling, and were analyzed through Partial Least Squares Structural Equation Modeling. The findings reveal that Service Quality has a positive and significant direct effect on Customer Satisfaction, Customer Trust, and Customer Loyalty, while Price Fairness is only proven to significantly influence Customer Trust. The direct effect of Price Fairness on Customer Loyalty was not significant. Although all four specific mediation paths were individually non-significant, Service Quality was proven to operate through aggregate mediation, categorized as complementary partial mediation, whereas Price Fairness demonstrated a non-mediation pattern. The novelty of this research lies in testing a dual mediation model that simultaneously compares satisfaction and trust pathways within the context of an Indonesian independent workshop with premium pricing characteristics. The findings indicate an evaluative fusion phenomenon between Customer Satisfaction and Customer Trust, suggesting that in services characterized by high technical information asymmetry, customers tend to merge satisfaction and trust evaluations into a single holistic assessment, rendering the independence of both pathways unverifiable through cross-sectional design.

BackgroundNear‐miss reporting intention is essential for patient safety; however, reporting rates among nurses remain low. Nurses’ silence behavior—the intentional withholding of work‐related concerns—is a key barrier to reporting. While authentic leadership is known to promote nurses’ voice behavior, research examining the relationships between authentic leadership, nurses’ silence behavior, and near‐miss reporting intention remains limited. Therefore, this study aimed to examine the abovementioned relationships and to test the mediating role of nurses’ silence behavior.MethodsA predictive correlation design was used. Data were collected from 171 nurses at three general and tertiary hospitals in South Korea between August 20 and September 15, 2022. The mediating effect of silence behavior on the relationship between authentic leadership and near‐miss reporting intention was tested using the PROCESS macro (Model 4).ResultsAuthentic leadership was negatively associated with nurses’ silence behavior (B = −0.27, p < 0.001), and silence behavior was negatively associated with near‐miss reporting intention (B = −0.65, p = 0.008). Authentic leadership did not have a significant direct effect on near‐miss reporting intention (B = 0.36, p = 0.142) but had a significant indirect effect through the mediator (B = 0.18, 95% CI = 0.03–0.37).ConclusionAuthentic leadership is indirectly linked to higher near‐miss reporting intentions through lower individual silence behavior among nurses. To enhance reporting intentions, it is necessary to mitigate situational constraints associated with silence and foster an environment conducive to open communication.Implications for Nursing ManagementNurse managers should consistently practice authentic leadership to dismantle rigid hierarchical atmospheres and cultivate an open communication climate. This targeted strategy may help reduce nurses’ silence behavior and encourage active participation in patient safety–strengthening behaviors, thereby creating a secure healthcare setting.

Background/Objectives: While previous research has explored the effects of moral distress and the work environment separately, there is limited evidence on how these two factors are associated with nurses' turnover intention. Therefore, in this study, we assessed the mediating role of moral distress in the correlation between nurses' work environments and turnover intention. Methods: This study employed a multicenter cross-sectional design of emergency nurses from April to June 2025. The Measure of Moral Distress-Healthcare Professionals, Practice Environment Scale of the Nursing Work Index (PES-NWI), and Turnover Intention Scale were used to collect data. The mediating effect was analyzed using Hayes' PROCESS macro (Model 4, Version 4.2) software with the bootstrap technique (5000 repetitions, 95% bias-corrected confidence interval). Statistical significance was set at a threshold of p < 0.05. Results: Mediation analysis revealed that work environment had a significant negative effect on moral distress (β = -0.251, B = -45.293, 95% CI [-70.376, -20.210], p < 0.001). Moral distress significantly increased nurse turnover (β = 0.202, B = 0.008, 95% CI [0.003, 0.012], p = 0.003), while the work environment had a significant negative direct effect on turnover (β = -0.391, B = -2.629, 95% CI [-3.507, -1.751], p < 0.001). The total effect of work environment on nurse turnover was also significant (β = -0.442, B = -2.970, 95% CI [-3.837, -2.102], p < 0.001). Bootstrapping confirmed a significant indirect effect of moral distress (β = -0.051, 95% CI [-0.092, -0.016]), indicating partial mediation. Conclusions: This study revealed that nurses' work environment was significantly associated with turnover intention, both directly and indirectly, through moral distress. Moral distress acted as a statistically significant but modest partial mediator of the association between the work environment and turnover intention, suggesting that it may partially explain this relationship. Strategies by healthcare organizations should be organized to optimize proactive work environments and mitigate moral distress among nurses.

Social participation in old age is beneficial for the individual and the community. However, very old adults are confronted with specific challenges regarding their resources, values, and social networks. In a rapidly changing society, very old adults may experience conflicts resulting in individual experiences of anomie which we understand as feelings of disorientation. They can have negative effects on their social participation. Using data from the population-based survey Old Age in Germany (D80+), we examined whether individual experiences of anomie played a mediating role in explaining very old adults’ social participation. Based on the civic voluntarism model and theories of anomie and ageing, hypotheses were derived and tested using a structural equation model (SEM). Predictors included in the model were socio-economic and health resources, individual values, and social relationships. The SEM revealed significant indirect effects through anomie for education, income, and health. Direct effects on social participation were significant for all predictors except income. While mediation through anomie played a minor role for education and health, its importance for income was greater. Furthermore, model results showed a significant direct effect of all predictors on anomie and of anomie on social participation. While the predictors of social participation according to the civic voluntarism model could be confirmed for very old age, individual experiences of anomie seemed to play a crucial mediating role only for income. The model indicated that not income itself, but rather the insecurities caused by relative deprivation, influenced the social participation of very old adults.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-026-00926-9.

ObjectiveTo examine the association between organizational dehumanization (OD) and nursing staff’s perceived stress and to test whether perceived stress statistically mediates the relationship between OD and patient depersonalization, as proposed by the spillover model.DesignCross‐sectional online survey.MethodologyA total of 291 registered nurses in France completed an online questionnaire measuring OD, perceived stress, and depersonalization. Mediation analysis with bias‐corrected bootstrapping was used to examine the hypothesized pathway linking OD to patient depersonalization through perceived stress.ResultsOD is significantly associated with perceived stress. Perceived stress functioned as a partial and statistically significant mediator in the relationship between OD and depersonalization. A significant direct effect of OD on depersonalization persisted, suggesting that stress only partially explains the relationship.ConclusionsThe findings provide cross‐sectional support for the spillover hypothesis: OD is associated with psychological strain which in turn is associated with depersonalized attitudes toward patients. These findings suggest that OD may be part of a stressful work climate in which depersonalization is more likely to be observed, although causal interpretations cannot be drawn.ImpactThe results highlight OD as a potential psychosocial risk factor for nurses and as a contextual correlate of depersonalization in patient care. Policies should be informed by further longitudinal and intervention studies before drawing firm conclusions about mechanisms or causality. Also, interventions should prioritize reducing the perceived stress of staff and restoring the ethical quality of the work environment over merely managing individual stress.Implication for Nursing ManagementThese findings suggest that nursing managers should address OD as a contextual risk factor by reducing dehumanizing organizational practices and strengthening ethical, resource‐preserving work conditions, rather than relying solely on individual stress‐management strategies.

Perceived partner support during pregnancy influences maternal mental health and antenatal care utilization. However, limited evidence exists regarding how different dimensions of partner support relate to pregnancy-related anxiety and fear of childbirth, and the mechanisms underlying these associations. This study examined the associations between perceived partner support, pregnancy-related anxiety, antenatal care utilization, and fear of childbirth, and explored the mediating role of pregnancy-related anxiety. A total of 331 pregnant women were included in this cross-sectional study. Data were collected using the Personal Information Form, the Perceived Partner Support Scale, the Pregnancy-Related Anxiety Scale, and the Wijma Delivery Expectancy/Experience Questionnaire. Binary logistic regression analysis was conducted to identify the determinants of regular antenatal care utilization. Hierarchical linear regression analysis was conducted to examine the determinants of pregnancy-related anxiety. After controlling for sociodemographic and relational variables, a mediation analysis was conducted using Hayes' PROCESS macro (Model 4) with 5,000 bootstrap samples. Financial support was a significant negative predictor of pregnancy-related anxiety (B = - 2.19, p < 0.001), while pregnancy-related anxiety was positively associated with fear of childbirth (B = 0.88, p < 0.001). Financial support also had a significant direct effect on fear of childbirth (B = - 1.47, p = 0.002). The mediation analysis showed that pregnancy-related anxiety partially mediated the relationship between financial support and fear of childbirth (indirect effect = - 1.93, 95%CI [- 2.73, - 1.27]). Additionally, the logistic regression analysis indicated that financial support significantly increased the likelihood of regular antenatal care utilization (OR = 1.66, p = 0.024), while higher pregnancy-related anxiety was associated with a decreased likelihood of regular antenatal care utilization (OR = 0.91, p = 0.014). All models were statistically significant (p < 0.001). Partner support during pregnancy plays a multifaceted role in maternal psychological well-being and health-related behaviors. Partners' financial support emerged as a key protective factor associated with lower pregnancy-related anxiety, reduced fear of childbirth, and greater utilization of antenatal care. Pregnancy-related anxiety serves as an important mediating mechanism. These findings underscore the importance of family-centered antenatal care approaches that actively involve partners and address both psychosocial and structural support needs.

ABSTRACT Amid the digital transformation of global trade, understanding how resource-constrained creative firms navigate international expansion is increasingly vital. Drawing on resource orchestration theory, this study examines how internal strategic capabilities and external institutional resources influence the international performance of Taiwanese cultural and creative firms, while accounting for diverse cross-border entry modes. Analysis of 153 firms using structural equation modeling reveals that innovation capability emerges as the sole significant driver of international performance, underscoring its role as a critical resource-bundling mechanism for creative firms. Conversely, digital capability, government support, and relationship networks exhibit no significant direct effects. For these micro-sized creative firms, resource constraints necessitate prioritizing product uniqueness to attract international buyers. Furthermore, widespread digital platform adoption has fostered technological homogeneity, shifted the role of trade support systems, and blurred business-to-business/business-to-consumer boundaries. These findings offer critical implications for policy formulation and strategic management within the creative industry.

Asthma is a clinically heterogeneous airway disorder characterized by complex interactions between environmental exposures, immune activation, and molecular regulatory programs, whose underlying mechanisms are not fully elucidated by known genetic loci. DNA methylation serves as a mechanistic interface bridging genetic predisposition and environmental influences; however, most epigenetic studies remain confined to isolated CpG sites, lacking robust biological interpretability. We developed a cross-tissue, multi-cohort, and mechanistically interpretable epigenetic framework to delineate pathway-level methylation mechanisms underlying asthma. Leveraging data from 908 participants across one combined training cohort and three independent validation cohorts, we constructed a linear support vector classifier based on pathway-derived methylation scores. Additionally, SHapley Additive exPlanations (SHAP) were applied to quantify the contributions of individual pathways. To assess the statistical significance of pathway contributions, one-sample t-tests were performed for each pathway's SHAP values against zero, followed by Benjamini-Hochberg false discovery rate (FDR) correction to obtain adjusted p values. The model exhibited reproducible and cross-tissue performance, achieving area under the curve (AUC) values of 0.792 (95% CI: 0.782-0.799; GSE65163) and 0.980 (95% CI: 0.974-0.990; GSE201872) in two airway epithelial cohorts, and 0.736 (95% CI: 0.690-0.771; GSE104471) in peripheral blood samples. Pathway interpretability analyses identified dominant roles of amino acid metabolism, epithelial and mesodermal developmental programs, metabolic-immune transport pathways, and neuroimmune signalling in shaping asthma-associated methylation patterns. Mediation analyses further revealed that these pathways influence asthma both directly and indirectly via eosinophil activity, epithelial proliferative dynamics, and nitric oxide-linked airway inflammation. Notably, pathways annotated by GO:0061205 and GO:0098727 exerted significant direct effects independent of immune intermediates. This study describes a pathway-level methylation model designed for biological interpretability that shows associations with both clinical severity and latent molecular heterogeneity. It provides statistical evidence contributing to the understanding of epigenetic, immune, and metabolic signatures in asthma, offering a potential framework warranting further validation for precision respiratory medicine.

Emotion dysregulation (ED) is increasingly recognized as a transdiagnostic factor in adolescent psychopathology and suicidal ideation and behavior. This study examined the association between ED and recent suicide attempts (SAs) in a clinically referred adolescent sample (n = 182; mean age = 15.70 ± 1.44 years; 80.8% female). We compared adolescents with recent SAs (n = 41) to psychiatric controls (n = 141) on diagnostic and dimensional variables, including the RIPoSt-Y, a novel measure of ED. Adolescents with SAs had higher rates of major depressive episodes (MDEs), depressive symptoms, and significantly elevated RIPoSt-Y interpersonal sensitivity and affective instability. Sequential logistic regressions revealed that both MDE diagnosis and interpersonal sensitivity independently predicted recent SAs, with the latter showing incremental predictive value beyond depressive symptoms. Mediation analysis using structural equation modeling indicated that interpersonal sensitivity had both a significant direct effect and a smaller indirect effect mediated by MDE and depressive symptoms. The total model explained 32.7% of the variance. Findings support the role of interpersonal sensitivity as a dispositional vulnerability of adolescent suicidal behavior, partially mediated by depression. This is the first study to demonstrate the predictive value of RIPoSt-Y dimensions for SAs in youth, underscoring the clinical importance of ED assessment in suicide risk evaluation.