Moderated BMI accumulation modified associations between blood benzene, toluene, ethylbenzene and xylene (BTEX) and phenotypic aging: mediating roles of inflammation and oxidative stress.

The associations between blood benzene, toluene, ethylbenzene, and xylenes (BTEX) and biological aging among the general adult population remain elusive. The present study comprised 5,780 participants from the National Health and Nutrition Examination Survey 1999-2010. A novel measure of biological aging, phenotypic age acceleration (PhenoAge.Accel), derived from biochemical markers was calculated. Weighted generalized linear regression and weighted quantile sum regression (WQS) were utilized to assess the associations between BTEX components and mixed exposure, and PhenoAge.Accel. The mediating roles of systemic immune-inflammation index (SII) and oxidative stress indicators (serum bilirubin and gamma-glutamyl transferase, GGT), along with the modifying effects of body mass index (BMI) were also examined. In the single-exposure model, the highest quantile of blood benzene (b = 0.89, 95%CI: 0.58 to 1.20), toluene (b = 0.87, 95%CI: 0.52 to 1.20), and ethylbenzene (b= 0.80, 95%CI: 0.46 to 1.10) was positively associated with PhenoAge.Accel compared to quantile 1. Mixed-exposure analyses revealed a consistent positive association between BTEX mixed exposure and PhenoAge.Accel(b=0.88, 95%CI: 0.56 to 1.20), primarily driven by benzene (92.78%). The association between BTEX and PhenoAge.Accel was found to be partially mediated by inflammation and oxidative stress indicators (ranging from 3.2% to 13.7%). Additionally, BMI negatively modified the association between BTEX mixed exposure and PhenoAge.Accel, with a threshold identified at 36.2 kg/mˆ2. Furthermore, BMI negatively moderated the direct effect of BTEX mixed exposure on PhenoAge.Accel in mediation models, while positively modifying the link between SII and PhenoAge.Accel in the indirect path (b interaction= 0.04, 95%CI: 0.04 to 0.06). Overall, BTEX mixed exposure was associated with PhenoAge.Accel among US adults, with benzene may have reported most contribution, and inflammation and oxidative damage processes may partially explain this underlying mechanism. The study also highlighted the potential benefits of appropriate BMI increased. Additional large-scale cohort studies and experiments were necessary to substantiate these findings.

Understanding the predictors of health professionals' intention to use electronic health record system: extend and apply UTAUT3 model.

BACKGROUND: The implementation of Electronic Health Record (EHR) systems is a critical challenge, particularly in low-income countries, where behavioral intention plays a crucial role. To address this issue, we conducted a study to extend and apply the Unified Theory of Acceptance and Use of Technology 3 (UTAUT3) model in predicting health professionals' behavioral intention to use EHR systems. METHODS: A quantitative research approach was employed among 423 health professionals in Southwest Ethiopia. We assessed the validity of the proposed model through measurement and structural model statistics. Analysis was done using SPSS AMOS version 23. Hypotheses were tested using structural equation modeling (SEM) analysis, and mediation and moderation effects were evaluated. The associations between exogenous and endogenous variables were examined using standardized regression coefficients (ß), 95% confidence intervals, and p-values, with a significance level of p-value < 0.05. RESULTS: The proposed model outperformed previous UTAUT models, explaining 84.5% (squared multiple correlations (R2) = 0.845) of the variance in behavioral intention to use EHR systems. Personal innovativeness (ß = 0.215, p-value < 0.018), performance expectancy (ß = 0.245, p-value < 0.001), and attitude (ß = 0.611, p-value < 0.001) showed significant associations to use EHR systems. Mediation analysis revealed that performance expectancy, hedonic motivation, and technology anxiety had significant indirect effects on behavioral intention. Furthermore, moderation analysis indicated that gender moderated the association between social influence, personal innovativeness, and behavioral intention. CONCLUSION: The extended UTAUT3 model accurately predicts health professionals' intention to use EHR systems and provides a valuable framework for understanding technology acceptance in healthcare. We recommend that digital health implementers and concerned bodies consider the comprehensive range of direct, indirect, and moderating effects. By addressing personal innovativeness, performance expectancy, attitude, hedonic motivation, technology anxiety, and the gender-specific impact of social influence, interventions can effectively enhance behavioral intention toward EHR systems. It is crucial to design gender-specific interventions that address the differences in social influence and personal innovativeness between males and females.

Trait Mindfulness Moderates Treatment Outcomes in a Randomized Controlled Trial of Mantram Repetition Program for Veterans with Post-Traumatic Stress Disorder.

Objectives: This secondary analysis examined five facets of mindful awareness as potential moderators of clinical outcomes using data from a randomized controlled trial (RCT) that compared Mantram Repetition Program (MRP) with present-centered therapy (PCT) in veterans with post-traumatic stress disorder (PTSD). Methods: Data were examined from 173 veterans with military-related PTSD randomly assigned to receive eight sessions of MRP (n = 89) or PCT (n = 84). Clinician-administered and self-report measures of mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), PTSD severity, insomnia symptoms, and depression symptoms, and were obtained pre- and post-intervention. Hierarchical regressions were used to test for FFMQ moderation on clinical outcomes within the two treatment groups. Results: For those with greater ability to "describe their internal experience" (+1 standard deviation [SD]), MRP was associated with lower PTSD hyperarousal symptoms post-intervention than PCT (p < 0.001). For those with lower "nonreactivity to internal stimuli" (-1 SD), MRP was associated with greater reductions in PTSD avoidance and numbing symptoms and insomnia compared with PCT (all ps < 0.002). Conclusions: Pre-intervention mindfulness domains of "describe" and "nonreactivity to inner experience" differentially predicted improvements in PTSD and insomnia symptoms for MRP as compared with PCT subjects. The FFMQ may be an important tool for predicting patient preparedness for mindfulness-based interventions, such as MRP.

Examining the interplay between physical activity, problematic internet use and the negative emotional state of depression, anxiety and stress: insights from a moderated mediation path model in university students.

BACKGROUND: The aim of this study was to investigate the relationship between Problematic Internet Use (PIU), emotional states of stress, anxiety and depression, and the practice of physical activity among Tunisian students. METHODS: Cross-sectional data were collected from 976 university students aged 20.76 ± 1.63 years (46.8% female). They filled out an online survey comprised of a socio-demographic questionnaire, the depression, anxiety and stress scale- 21 items (DASS-21), the international physical activity questionnaire (IPAQ) and the compulsive internet use scale (CIUS). Students were divided, based on their economic levels, into three groups: low (n = 256, 26.23%), medium (n = 523, 53.59%) and high (n = 197, 20.18%). RESULTS: Mediation analysis: Indirect effects of IPAQ and gender on DASS-21 were highlighted: ß= -0.18 (p < 0.01) and ß= -0.04, P < 0.01) respectively. In addition, a significant and negative effect of IPAQ on CIUS was demonstrated (ß = -0.45, P < 0.01). In addition, the effect of CIUS on DASS-21 was significant (ß = 0.39, P < 0.01). Also, the effect of gender on CIUS was significant (ß=-0.10, P < 0.01) However, its effect on DASS-21 was not significant (ß = 0.05, p = 0.078). The total effect of IPAQ on DASS21 was significant (ß= -0.52, p < 0.01) but the effect of Gender on DASS-21 was not significant (ß = 0.01, p = 0.817). Moderation analysis: the results showed a significant moderation effect of the interaction between IPAQ and Gender on CIUS (ß = 0.07, p < 0.01). However, it was not significant between Gender and CIUS on DASS-21 (ß = 0.09, p = 0.390) and between IPAQ and Gender on DASS21 (ß = 0.01, p = 0.736) Also, the interaction between IPAQ and CIUS did not have a significant moderation effect on DASS-21 (ß = 0.15, p = 0.115). CONCLUSIONS: Findings suggest that relationships between PIU and negative emotional state of depression, anxiety and stress are mediated via physical exercise. These results underscore the importance of the physical activity factor in the studies analyzing longitudinal effects of PIU on mental health outcomes.

Association of cerebrospinal fluid NPY with peripheral ApoA: a moderation effect of BMI.

BACKGROUND: Apoprotein A-I (ApoA-I) and Apoprotein B (ApoB) have emerged as novel cardiovascular risk biomarkers influenced by feeding behavior. Hypothalamic appetite peptides regulate feeding behavior and impact lipoprotein levels, which effects vary in different weight states. This study explores the intricate relationship between body mass index (BMI), hypothalamic appetite peptides, and apolipoproteins with emphasis on the moderating role of body weight in the association between neuropeptide Y (NPY), ghrelin, orexin A (OXA), oxytocin in cerebrospinal fluid (CSF) and peripheral ApoA-I and ApoB. METHODS: In this cross-sectional study, we included participants with a mean age of 31.77 ± 10.25 years, categorized into a normal weight (NW) (n = 73) and an overweight/obese (OW/OB) (n = 117) group based on BMI. NPY, ghrelin, OXA, and oxytocin levels in CSF were measured. RESULTS: In the NW group, peripheral ApoA-I levels were higher, while ApoB levels were lower than in the OW/OB group (all p < 0.05). CSF NPY exhibited a positive correlation with peripheral ApoA-I in the NW group (r = 0.39, p = 0.001). Notably, participants with higher CSF NPY levels had higher peripheral ApoA-I levels in the NW group and lower peripheral ApoA-I levels in the OW/OB group, showing the significant moderating effect of BMI on this association (R2 = 0.144, ß=-0.54, p < 0.001). The correlation between ghrelin, OXA and oxytocin in CSF and peripheral ApoB in both groups exhibited opposing trends (Ghrelin: r = -0.03 and r = 0.04; OXA: r = 0.23 and r=-0.01; Oxytocin: r=-0.09 and r = 0.04). CONCLUSION: This study provides hitherto undocumented evidence that BMI moderates the relationship between CSF NPY and peripheral ApoA-I levels. It also reveals the protective role of NPY in the NW population, contrasting with its risk factor role in the OW/OB population, which was associated with the at-risk for cardiovascular disease.

Do Mathematics and Reading Skills Impact Student Science Outcomes?

Establishing validated science programs for students with or at risk for learning disabilities requires testing treatment effects and exploring differential response patterns. This study explored whether students' initial mathematics and reading skills influenced their treatment response to a whole-class, second-grade science program called Scientific Explorers (Sci2). The original Sci2 study employed a cluster randomized controlled design and included 294 students from 18 second-grade classrooms. Differential effects of the program by initial mathematics and reading skill levels were not observed for an interactive science assessment and a distal science outcome measure. However, based on initial reading skill levels, moderation results were found on a science vocabulary measure, suggesting the effects of Sci2 were greatest for students with higher initial reading skills. Similar results were found using initial mathematics skill levels as a predictor of differential response such that students with higher mathematics skills reaped stronger treatment effects on the vocabulary measure. Further, we found initial mathematics skills also influenced outcomes on the proximal science content assessment, where students with higher initial mathematics skills led to higher outcomes. Overall, findings suggest Sci2 produced robust effects for all students (g = 0.24-1.23), regardless of initial skill proficiencies. Implications for exploring differential response in science intervention research are discussed.

Can good neighbourhood perception magnify the positive effect of favourable built environment on recreational walking in China?

BACKGROUND: It remains unknown whether good neighbourhood perception can enhance the benefits of favourable built environment to physical activity. Moreover, the moderation pattern is less understood in developing countries. OBJECTIVES: This work aims to examine the moderation effects of perceived neighbourhood safety and aesthetics on the relationship between built environment and time for recreational walking. METHODS: We performed the examination using a sample of 760 residents in Fuzhou City, China. The Negative Binomial Regression Model was developed to examine the moderation roles of neighbourhood safety and aesthetics on the impact of built environment, adjusting for the effects of location, socioeconomic, personal preferences and social environment factors. Moreover, two sensitivity analyses were performed to test whether the moderators found are robust to the control of residential self-selection, and differential measures of conceptually-comparable aspects of built environment. RESULTS: We found stronger associations of time for recreational walking with road density and proportion of parks and squares POIs for residents with high perception of neighbourhood safety, compared to those with low perception of neighbourhood safety. There was a greater effect of the proportion of parks and squares POIs, when perceived aesthetics was high than when perceived aesthetics was low. The findings of neighbourhood safety and aesthetics as moderator, were robust in the two sensitivity analyses. No significant moderation effect was found for land use diversity. CONCLUSIONS: High perceived neighbourhood safety can magnify the positive effects of road connectivity and accessibility to parks and squares. Neighbourhood aesthetics positively moderates the association of time for recreational walking with accessibility to parks and squares. The findings emphasize the need to consider safety- and aesthetics-specific differences in estimates of built environment effects. Improvements in neighbourhood safety and aesthetics are key to effective interventions in built environment to better promote physical activity.

Mind over chronic pain: A meta-analysis of cognitive restructuring in chronically ill adults.

OBJECTIVE: This meta-analysis synthesizes research on the impact of cognitive restructuring on chronic pain intensity, aiming to integrate diverse methodologies and findings while evaluating potential moderators. METHODS: Following PRISMA guidelines, we systematically searched multiple databases (PubMed, Web of Science, JSTOR, Sage, Social Science Research Network, PsycArticles, ScienceDirect, and Education Resources Information Center) until July 2023. Studies involving adults (≥18 years) diagnosed with chronic conditions who underwent cognitive restructuring to reduce chronic pain intensity, were included. Eligible studies compared this intervention with a control group. We excluded studies incorporating cognitive restructuring within broader interventions, lacking statistical data, or not written in English. Study quality was assessed using the Cochrane Risk of Bias tool (RoB 2). RESULTS: After reviewing 18,312 studies, we selected 11 studies published between 1991 and 2022, involving 693 participants with chronic conditions. A significant large overall effect size was found (d = 0.94, 95% CI 0.48 to 1.40). Moderation analyses revealed significant differences based on sex and study quality, with effects less pronounced among females and more substantial in higher-quality studies. CONCLUSION: Despite limitations such as statistical instability due to a small number of studies in certain moderator categories and methodological variability, this meta-analysis highlights the robust effects of cognitive restructuring on chronic pain intensity. The findings are valuable for guiding power calculations and future research expectations. Clinically, these results support the significant effect of cognitive restructuring in both individual and group settings, regardless of age, particularly when facilitated by teams that include psychologists.

Moderation Effects of Streetscape Perceptions on the Associations Between Accessibility, Land Use Mix, and Bike-Sharing Use: Cross-Sectional Study.

Background: Cycling is known to be beneficial for human health. Studies have suggested significant associations of physical activity with macroscale built environments and streetscapes. However, whether good streetscapes can amplify the benefits of a favorable built environment on physical activity remains unknown. Objective: This study examines whether streetscape perceptions can modify the associations between accessibility, land use mix, and bike-sharing use. Methods: This cross-sectional study used data from 18,019,266 bike-sharing orders during weekends in Shanghai, China. A 500 × 500 m grid was selected as the analysis unit to allocate data. Bike-sharing use was defined as the number of bike-sharing origins. Street view images and a human-machine adversarial scoring framework were combined to evaluate lively, safety, and wealthy perceptions. Negative binomial regression was developed to examine the independent effects of the three perceptual factors in both the univariate model and fully adjusted model, controlling for population density, average building height, distance to nearest transit, number of bus stations, number of points of interest, distance to the nearest park, and distance to the central business district. The moderation effect was then investigated through the interaction term between streetscape perception and accessibility and land use mix, based on the fully adjusted model. We also tested whether the findings of streetscape moderation effects are robust when examinations are performed at different geographic scales, using a small-sample statistics approach and different operationalizations of land use mix and accessibility. Results: High levels of lively, safety, and wealthy perceptions were correlated with more bike-sharing activities. There were negative effects for the interactions between the land use Herfindahl-Hirschman index with the lively perception (ß=-0.63; P=.01) and safety perception (ß=-0.52; P=.001). The interaction between the lively perception and road intersection density was positively associated with the number of bike-sharing uses (ß=0.43; P=.08). Among these, the lively perception showed the greatest independent effect (ß=1.29; P<.001), followed by the safety perception (ß=1.22; P=.001) and wealthy perception (ß=0.72; P=.001). The findings were robust in the three sensitivity analyses. Conclusions: A safer and livelier streetscape can enhance the benefits of land use mix in promoting bike-sharing use, with a safer streetscape also intensifying the effect of accessibility. Interventions focused on streetscape perceptions can encourage cycling behavior and enhance the benefits of accessibility and land use mix. This study also contributes to the literature on potential moderators of built environment healthy behavior associations from the perspective of microscale environmental perceptions.

Impact of state and trait emotion regulation on daily emotional exhaustion among Korean school counsellors.

School counsellors in South Korea face significant emotional exhaustion due to their challenging occupational environment. Previous studies have shown that cognitive reappraisal (CR) reduces emotional exhaustion, whereas expressive suppression (ES) increases it. However, these findings predominantly rely on trait questionnaires within cross-sectional approaches, overlooking the dynamic nature of emotion regulation (ER) strategy selection. Individuals may choose strategies that deviate from their general tendencies based on situational demands. There is limited empirical knowledge regarding the interaction between trait and state regulation strategies and their influence on exhaustion. Utilizing the strategy-situation fit hypothesis, this study examines the context-specific effects of ER strategies, considering both situational contexts and individual response tendencies. A multilevel analysis was performed to examine the influence of state and trait ER strategies on daily emotional exhaustion. A daily diary study was conducted for 5 days with 111 Korean school counsellors. Daily CR was associated with lower daily exhaustion and daily ES predicted higher daily exhaustion. Contrastingly, none of the trait ER strategies had an impact on daily exhaustion, but the trait level of both strategies significantly moderated the relationship between daily CR and exhaustion. The positive impact of daily CR was more pronounced in school counsellors who often utilized suppression strategies, and this impact was also evident in trait reappraisal. Re-evaluating daily emotions instead of suppressing them may assist in coping with emotional exhaustion caused by work. The effectiveness of these strategies may vary based on an individual's inclination to regulate emotions as state and trait. ER may aid in implementing preventive interventions for school counsellors experiencing emotional exhaustion.

Assessing Additive Interactions between Protective Factors Using Relative Risk Reduction Due to Interaction.

Background and Objectives: In the context of disease prevention, interaction on an additive scale is commonly assessed to determine synergistic effects between exposures. While the "Relative Excess Risk due to Interaction" represents the main measure of additive interaction between risk factors, in this study we aimed to extend this approach to assess additive interaction between factors known to prevent the event's occurrence, such as medical interventions and drugs. Materials and Methods: We introduced and described the "Relative Risk Reduction due to Interaction" (RRRI) as a key measure to assess additive interactions between preventive factors, such as therapeutic interventions and drug combinations. For RRRI values closer to 1, the combination of exposures has a greater impact on reducing the event risk due to their interaction. As a purely illustrative example, we re-evaluated a previous investigation of the synergistic effect between statins and blood pressure-lowering drugs in preventing major adverse cardiovascular events (MACE). Moreover, simulation studies were used to empirically evaluate the performance of a robust Poisson regression model to estimate RRRI across different scenarios. Results: In our example, the drug combination revealed a positive additive interaction in further reducing MACE risk (RRRI > 0), even if not statistically significant. This result is more straightforward to interpret as compared to the original one based on the RERI. Additionally, our simulations highlighted the importance of large sample sizes for detecting significant interaction effects. Conclusion: We recommend RRRI as the main measure to be considered when exploring additive interaction effects between protective exposures, such as the investigation of synergistic effects between drug combinations or preventive treatments.

People with short symptom duration of knee osteoarthritis benefit more from exercise therapy than people with longer symptom duration: An individual participant data meta-analysis from the OA trial bank.

OBJECTIVE: To investigate whether duration of knee symptoms influenced the magnitude of the effect of exercise therapy compared to non-exercise control interventions on pain and physical function in people with knee osteoarthritis (OA). METHOD: We undertook an individual participant data (IPD) meta-analysis utilising IPD stored within the OA Trial Bank from randomised controlled trials (RCTs) comparing exercise to non-exercise control interventions among people with knee OA. IPD from RCTs were analysed to determine the treatment effect by considering both study-level and individual-level covariates in the multilevel regression model. To estimate the interaction effect (i.e., treatment x duration of symptoms (dichotomised)), on self-reported pain or physical function (standardised to 0-100 scale), a one-stage multilevel regression model was applied. RESULTS: We included IPD from 1767 participants with knee OA from 10 RCTs. Significant interaction effects between the study arm and symptom duration (≤1 year vs >1 year, and ≤2 years vs>2 years) were found for short- (~3 months) (Mean Difference (MD) -3.57, 95%CI -6.76 to -0.38 and -4.12, 95% CI-6.58 to -1.66, respectively) and long-term (~12 months) pain outcomes (MD -8.33, 95%CI -12.51 to -4.15 and -8.00, 95%CI -11.21 to -4.80, respectively), and long-term function outcomes (MD -5.46, 95%CI -9.22 to -1.70 and -4.56 95%CI -7.33 to-1.80, respectively). CONCLUSIONS: This IPD meta-analysis demonstrated that people with a relatively short symptom duration benefit more from therapeutic exercise than those with a longer symptom duration. Therefore, there seems to be a window of opportunity to target therapeutic exercise in knee OA.

Exploring Relations Between Unique Patient Characteristics and Virtual Reality Immersion Level on Anxiety and Pain in Patients Undergoing Venipuncture: Secondary Analysis of a Randomized Control Trial.

BACKGROUND: Virtual reality (VR) is a well-researched digital intervention that has been used for managing acute pain and anxiety in pediatric patients undergoing various medical procedures. This study focuses on investigating the role of unique patient characteristics and VR immersion level on the effectiveness of VR for managing pediatric pain and anxiety during venipuncture. OBJECTIVE: The purpose of this study is to determine how specific patient characteristics and level of immersion during a VR intervention impact anxiety and pain levels for pediatric patients undergoing venipuncture procedures. METHODS: This study is a secondary data analysis of 2 combined, previously published randomized control trials on 252 pediatric patients aged 10-21 years observed at Children's Hospital Los Angeles from April 12, 2017, to July 24, 2019. One randomized clinical trial was conducted in 3 clinical environments examining peripheral intravenous catheter placement (radiology and an infusion center) and blood draw (phlebotomy). Conditional process analysis was used to conduct moderation and mediation analyses to assess the impact of immersion level during the VR intervention. RESULTS: Significant moderation was found between the level of immersion and anxiety sensitivity when predicting postprocedural anxiety (P=.01). Patients exhibiting the highest anxiety sensitivity within the standard of care yielded a 1.9 (95% CI 0.9-2.8; P<.001)-point elevation in postprocedural anxiety relative to individuals with high immersion levels. No other significant factors were found to mediate or moderate the effect of immersion on either postprocedural anxiety or pain. CONCLUSIONS: VR is most effective for patients with higher anxiety sensitivity who report feeling highly immersed. Age, location of the procedure, and gender of the patient were not found to significantly impact VR's success in managing levels of postprocedural pain or anxiety, suggesting that immersive VR may be a beneficial intervention for a broad pediatric population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04268901; https://clinicaltrials.gov/study/NCT04268901.

Promoting walking as a self-care strategy in women with fibromyalgia: a cross­sectional study using accelerometers.

INTRODUCTION: Walking is a beneficial healthy lifestyle for fibromyalgia patients as it reduces the intensity of pain and fatigue experienced and improves quality of life. In this context, self-efficacy and commitment are potential predictors of walking for women with fibromyalgia. Present study aims at examining the moderation role of exercise commitment in the association between self-efficacy for walking and walking behavior in this population. METHOD: It is a cross­sectional study. A total of 132 women with fibromyalgia participated (mean age = 57.63, SD = 10.44) between January and December 2018. Self-efficacy about walking was assessed through Spanish version of self-efficacy scale for physical activity scale (SEPAS) and exercise commitment through ad-hoc questionnaire (two Likert-type items about the committed action of physical activity). Walking behavior was measured using accelerometers for seven consecutive days. Pain and fatigue prior to placement of the accelerometer were evaluated as possible covariates. Regarding medical history, time since onset of symptoms (i.e. pain, fatigue) and since diagnosis, and medication were also assessed as possible covariates. RESULTS: A moderation effect of exercise commitment was found in the relationship between self-efficacy on walking behavior (B = 10.48, p = .021, 95%, CI = 0.61 to 6.79). Post-hoc analyses showed a significant and positive relationship between self-efficacy and walking only with high commitment to physical activity (t = 10.08, p = .027, 95%, CI = 3.77 to 5.64). CONCLUSIONS: Self-efficacy for walking and commitment should be assessed and potentially targeted when focusing on increasing walking in women with fibromyalgia. Key Points • Associations between walking self-efficacy and exercise engagement provide indications of modifiable targets for promoting an active lifestyle in fibromyalgia. • When patients feel engaged in their physical exercise pattern (walking), patients feel more able to perform the behavior. • Rehabilitation interventions, focused on chronic pain, should contemplate the promotion of self-efficacy and engagement.

Belief in a just world and fair behavior among clinical nurses: a moderated mediation model of empathy and observer justice sensitivity.

BACKGROUND: Exploration of the relationship between nursing staffs' justice in belief world and fair behavior is important to promote equity and access to health services in health organizations, as well as to enhance the quality of care. In order to further dissect the influencing factors of fair behavior among clinical nurses, the current study aims to investigate how belief in a just world influences the fair behavior among nurses. Based on the belief in a just world theory, the empathy-altruism theory and the protective-protective model, the current study aimed to provide a deeper understanding of the effect of belief in a just world on fair behavior by investigating the mediating role of empathy and the moderating role of observer justice sensitivity. METHOD: This was a cross-sectional study. 571 registered clinical nurses were included from five hospitals in Fuzhou through a convenience sampling method. Measurements included Chinese translations of belief in a just world scale, empathy scale, observer justice sensitivity scale, fair behavior scale. SPSS 22.0 was used to describe descriptive statistics and the variables' Pearson correlation coefficient. SPSS PROCESS macro Model 4 and model 14 were used to examine the mediation and the moderation between the relationship of belief in a just world and fairness behavior. RESULT: The results shower that fairness behavior was positively correlated with one's belief in a just world (r = 0.26, p < 0.01); (2)empathy mediated the relationship between belief in a just world and fair behavior. The mediation model explains 20.83%; (3) Observer justice sensitivity moderated the relationship between empathy and fair behavior. CONCLUSIONS: Belief in a just world, empathy, and observer justice sensitivity were motivations for nurses' fair behavior. Nursing administrators should focus on cultivating nurses' belief in a just world, their empathy abilities, and positive qualities of justice sensitivity to enhance fair behavior in a healthcare setting.

Built for movement: Neighborhoods and adolescent physical activity behaviors, and the moderating role of socioeconomic position and gender.

This study examined whether the built environment was associated with physical activity among adolescents in Oslo, Norway, and the role of socioeconomic position and gender as potential moderators of this association. We used data from 897 adolescents who participated in the TACKLE cross-sectional study conducted in 2020. Built environment features (recreational facilities, parks, forest, public transport, traffic calming devices, and schools) were assessed objectively using Geographical Information Systems. Physical activity data included device-measured moderate-to-vigorous physical activity, total physical activity, and self-reported active transportation to school. Using general linear models and logistic regression, we found that most built environment features were unrelated to the participants' device-measured physical activity. Longer distances to school and to traffic calming devices were associated with decreased likelihood of participants reporting active transportation to school. Our moderated regression analysis showed that adolescents with low socioeconomic backgrounds seemed less affected by longer distances to school compared with their high socioeconomic counterparts. Furthermore, boys appeared to be more sensitive to traffic safety relative to girls. Implementing traffic calming devices may enhance active transportation to school and improve traffic safety for Norwegian adolescents.

Effectiveness of public health spending: Investigating the moderating role of governance using partial least squares structural equation modelling (PLS-SEM).

BACKGROUND: The link between public health spending (PHS) and population health outcomes (PHO) has been extensively studied. However, in sub-Saharan Africa (SSA), the moderating effects of governance in this relationship are little known. Furthermore, studies have focused on mortality as the main health outcome. This study contributes to this literature by investigating the moderating role of governance in the relationship by simultaneously assessing three dimensions of governance (corruption control, government effectiveness and voice accountability) using disability-adjusted life years (DALYs) as a measure of outcomes. METHODS: The study applies the two-stage moderation approach using partial least squares structural equation modelling (PLS-SEM) to panel data from 43 SSA nations from 2013 to 2019. The study also uses domestic general government health expenditure (DGGHE) as an independent variable and disability-adjusted life years (DALY) as the dependent variable in this relationship. RESULTS: The analysis reveals that DGGHE affects DALY negatively and that governance improves the effect of DGGHE on DALY, with bigger improvements among countries with worse governance. CONCLUSION: These findings provide evidence that good governance is crucial to the effectiveness of PHS in SSA nations. Sub-Saharan Africa (SSA) countries should improve governance to improve population health.

A time-robust group recommender for featured comments on news platforms.

Introduction: Recently, content moderators on news platforms face the challenging task to select high-quality comments to feature on the webpage, a manual and time-consuming task exacerbated by platform growth. This paper introduces a group recommender system based on classifiers to aid moderators in this selection process. Methods: Utilizing data from a Dutch news platform, we demonstrate that integrating comment data with user history and contextual relevance yields high ranking scores. To evaluate our models, we created realistic evaluation scenarios based on unseen online discussions from both 2020 and 2023, replicating changing news cycles and platform growth. Results: We demonstrate that our best-performing models maintain their ranking performance even when article topics change, achieving an optimum mean NDCG@5 of 0.89. Discussion: The expert evaluation by platform-employed moderators underscores the subjectivity inherent in moderation practices, emphasizing the value of recommending comments over classification. Our research contributes to the advancement of (semi-)automated content moderation and the understanding of deliberation quality assessment in online discourse.

The Mediation/Moderation Effects of Gut Microbiota on Sleep Quality and Primary Liver Cancer: A Mendelian Randomization and Case-Control Study.

Background: Primary liver cancer (PLC) is a fatal malignancy, sleep quality and gut microbiota were shown to be associated with PLC. However, the mechanism of how sleep quality affects PLC is unclear. This study aims to investigate the mediation/moderation effects of gut microbiota on sleep quality and the occurrence of PLC. Methods: The causality of sleep quality and the occurrence of PLC was detected through the Mendelian randomization (MR) analysis based on the data including 305,359 individuals (Finland Database) and 456,348 participants (UK Biobank). The primary method used for MR analysis was inverse-variance weighted analysis. Gut microbiota' mediation/moderation effects were uncovered in the case-control study including 254 patients with PLC and 193 people with benign liver diseases through the mediation/moderation effect analyses. People's sleep quality was evaluated through the Pittsburgh sleep quality index (PSQI). Results: Poor sleep quality could lead to PLC through the MR analysis (P = 0.026). The case-control study uncovered that Actinobacteria had mediation effects on the relationship between PSQI score, self-sleep quality, and the occurrence of PLC (P = 0.048, P = 0.046). Actinobacteria and Bifidobacterium could inhibit the development of PLC caused by short night sleep duration (P = 0.021, P = 0.022). Erysipelotrichales could weaken the influence of daytime dysfunction on PLC (P = 0.033). Roseburia modulated the contribution of nocturnal insomnia and poor sleep quality to PLC (P = 0.009, P = 0.017). Conclusion: Poor sleep quality was associated with PLC. Gut microbiota' mediation/moderation effects on poor sleep quality and the occurrence of PLC prompted an insightful idea for the prevention of PLC.

An exploratory analysis of moderating effects in a non-randomized, quasi-experimental evaluation of a college-based mental health literacy curriculum.

Objective: To assess possible moderating variables that influence the effectiveness of a college-based mental health literacy curriculum, Mental Health Awareness and Advocacy (MHAA). Participants: Students at a Western University in the United States (MHAA treatment group: N = 474; Comparison group: N = 575). Methods: Using a non-randomized, quasi-experimental design over six semesters (2017-2019), students in the treatment and control groups reported on key demographic factors, experiences with mental health, and their knowledge, self-efficacy, and behaviors related to mental health literacy in a pretest/post-test format. Linear mixed effects models were used to assess moderation. Results: MHAA curriculum's efficacy varied based on participants' current depression and anxiety levels, whether they had prior personal experience with a mental health concern, whether they had been diagnosed with a mental health concern, and whether they had experienced suicidal thoughts. Conclusions: Reducing anxiety and depression among students may increase the efficacy of the MHAA program.