The Association Between Personality Traits and Health-Related Quality of Life and the Mediating Role of Smoking: Nationwide Cross-Sectional Study.

Background: There are positive and negative correlations in different directions between smoking, personality traits, and health-related quality of life (HRQOL), where smoking may mask the pathway between personality traits and HRQOL. Understanding the masking pathway of smoking between personality traits and HRQOL can elucidate the mechanisms of smoking's psychosocial effects and provide new ideas for developing tobacco control strategies. Objective: The purpose of this study was to investigate the correlation between Big Five personality traits and HRQOL and whether smoking mediates the relationship between them. Methods: This was a cross-sectional study using data from 21,916 respondents from the 2022 Psychology and Behavior Investigation of Chinese Residents survey. Linear regression models were used to analyze the correlations between smoking, Big Five personality traits, and HRQOL while controlling for potential confounders. The mediating role of smoking on the association between Big Five Personality traits and HRQOL was analyzed using the Sobel-Goodman mediation test. Results: Extraversion (ß=.001; P=.04), agreeableness (ß=.003; P<.001), and neuroticism (ß=.003; P<.001) were positively correlated with HRQOL, whereas openness was negatively correlated with HRQOL (ß=-.001; P=.003). Smoking was associated with a decrease in HRQOL and mediated the positive effect of HRQOL on extraversion (z=-2.482; P=.004), agreeableness (z=-2.264; P=.02), and neuroticism (z=-3.230; P=.001). Subgroup analyses further showed that smoking mediated the effect of neuroticism on HRQOL in the population with chronic illnesses (z=-2.724; P=.006), and in the population without chronic illnesses, smoking contributed to the effect of HRQOL on extraversion (z=-2.299; P=.02), agreeableness (z=-2.382; P=.02), and neuroticism (z=-2.213; P=.03). Conclusions: This study provided evidence that there is a correlation between personality traits and HRQOL. It also found that smoking plays a role in mediating the connection between personality traits and HRQOL. The development of future tobacco control strategies should consider the unique traits of each individual's personality, highlighting the significance of extraversion, agreeableness, and neuroticism.

Work addiction risk, stress and well-being at work: testing the mediating role of sleep quality.

Introduction: Attention to work addiction risk is growing; however, more studies are needed to explore the possible impact of work addiction risk on various aspects of employees' work and life domains. Although several studies have considered the antecedents or consequences of work addiction risk, this study particularly focuses on sleep quality as a potential explanatory underlying mechanism in the relation between work addition risk and three outcome variables including stress at home, stress at work and well-being. Method: The data was collected using an online platform and participants consisted of 188 French employees who were selected using simple random sampling method. Participants responded to the survey including the Work Addiction Risk Test (WART), stress at work, well-being, and sleep quality. The data was analyzed using JASP and SPSS-26 programs. Results: The results revealed that there are significant positive relationships between work addiction risk and both stress at home and at work and negative relationships between work addiction risk and both sleep quality and well-being. In addition, the analyses of the mediation paths suggest the significant mediation role of sleep quality for the link between work addition risk and stress at work as well as the link between work addiction risk and well-being. Discussion: Given the verified mediating role of sleep quality in the relationship between work addiction, stress and wellbeing, it is recommended that organizations and companies pay particular attention to their employees' sleep quality.

Body image, self-efficacy, and sleep quality among patients with breast cancer: A latent profile and mediation analysis.

PURPOSE: As a sign of femininity, impaired breast after surgery causes particularly confusion for patients with breast cancer resulting in increased body image distress, which has negative impacts on sleep quality. And self-efficacy enables patients to use positive and effective coping strategies to maintain a favorable night's sleep. Therefore, our study is to explore the heterogeneity in body image experienced by patients with breast cancer and to examine the mediation effects of self-efficacy between body image and sleep quality. METHOD: Between July 2023 and October 2023, 251 patients with breast cancer were recruited for the Be Resilient to Breast Cancer program. They responded to the General Perceived Self-Efficacy Scale, Body Image Scale, and Pittsburgh Sleep Quality Index Scale. Data were analyzed using a latent profile analysis (LPA) and mediation analysis. RESULTS: Results of the LPA indicated that body image could be classified into three subgroups as follows: low (43.0%), moderate (45.5%), and high (11.5%). Furthermore, the mediation analysis demonstrated two partially mediated effects upon comparing the low and moderate (standard error, SE = 0.548, 95% confidence interval, CI = 0.009, 0.366) and the high and low (SE = 0.848, 95% CI = 0.570, 3.909) body image groups. CONCLUSION: Heterogeneity exists in body image, and self-efficacy mediates the relationship between body image and sleep quality. Hence, promoting self-efficacy can buffer the negative impacts of body image on sleep quality in patients with breast cancer, and self-efficacy-orientated interventions should also receive more attention in clinic.

Impact of emotional abuse on eating disorder psychopathology: A multiple mediation analysis.

INTRODUCTION: Childhood maltreatment, particularly emotional abuse (EA), has been identified as a significant risk factor for the development of eating disorders (EDs). This study investigated the association between EA and ED symptoms while considering multiple potential mediators. METHODS: Participants included 151 individuals with Anorexia Nervosa (AN), 115 with Bulimia Nervosa (BN), and 108 healthy controls. The Childhood trauma questionnaire, the Toronto Alexithymia scale, the Behavioral inhibition System, and the Eating Disorder Inventory 2 scale were completed before treatment. A mediator path model was conducted in each group: EA was set as independent variable, eating symptoms as dependent variables and ineffectiveness, sensitivity to punishment, alexithymia, and impulsivity as mediators. RESULTS: In individuals with AN, impulsivity emerged as a significant mediator between EA and desire for thinness and bulimic behaviors. Conversely, in individuals with BN, sensitivity to punishment was found to mediate the association between EA and dissatisfaction with one's body. Ineffectiveness and difficulty identifying emotions were identified as transdiagnostic mediators in both clinical groups. No mediation effect was found in healthy individuals. DISCUSSION: The simultaneous assessment of multiple mediators in a unique model outlines the complex interplay between childhood EA and ED psychopathology. Improving ineffectiveness, emotion identification, sensitivity to punishment and impulsivity and exploring their relations with early emotional abuse may represent treatment targets in individuals with EDs and childhood trauma.

Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships.

BACKGROUND: Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation. METHODS: The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships. RESULTS: The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation. CONCLUSIONS: Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Choroid plexus volume as a novel candidate neuroimaging marker of the Alzheimer's continuum.

BACKGROUND: Enlarged choroid plexus (ChP) volume has been reported in patients with Alzheimer's disease (AD) and inversely correlated with cognitive performance. However, its clinical diagnostic and predictive value, and mechanisms by which ChP impacts the AD continuum remain unclear. METHODS: This prospective cohort study enrolled 607 participants [healthy control (HC): 110, mild cognitive impairment (MCI): 269, AD dementia: 228] from the Chinese Imaging, Biomarkers, and Lifestyle study between January 1, 2021, and December 31, 2022. Of the 497 patients on the AD continuum, 138 underwent lumbar puncture for cerebrospinal fluid (CSF) hallmark testing. The relationships between ChP volume and CSF pathological hallmarks (Aß42, Aß40, Aß42/40, tTau, and pTau181), neuropsychological tests [Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Neuropsychiatric Inventory (NPI), and Activities of Daily Living (ADL) scores], and multimodal neuroimaging measures [gray matter volume, cortical thickness, and corrected cerebral blood flow (cCBF)] were analyzed using partial Spearman's correlation. The mediating effects of four neuroimaging measures [ChP volume, hippocampal volume, lateral ventricular volume (LVV), and entorhinal cortical thickness (ECT)] on the relationship between CSF hallmarks and neuropsychological tests were examined. The ability of the four neuroimaging measures to identify cerebral Aß42 changes or differentiate among patients with AD dementia, MCI and HCs was determined using receiver operating characteristic analysis, and their associations with neuropsychological test scores at baseline were evaluated by linear regression. Longitudinal associations between the rate of change in the four neuroimaging measures and neuropsychological tests scores were evaluated on the AD continuum using generalized linear mixed-effects models. RESULTS: The participants' mean age was 65.99 ± 8.79 years. Patients with AD dementia exhibited the largest baseline ChP volume than the other groups (P < 0.05). ChP volume enlargement correlated with decreased Aß42 and Aß40 levels; lower MMSE and MoCA and higher NPI and ADL scores; and lower volume, cortical thickness, and cCBF in other cognition-related regions (all P < 0.05). ChP volume mediated the association of Aß42 and Aß40 levels with MMSE scores (19.08% and 36.57%), and Aß42 levels mediated the association of ChP volume and MMSE or MoCA scores (39.49% and 34.36%). ChP volume alone better identified cerebral Aß42 changes than LVV alone (AUC = 0.81 vs. 0.67, P = 0.04) and EC thickness alone (AUC = 0.81 vs.0.63, P = 0.01) and better differentiated patients with MCI from HCs than hippocampal volume alone (AUC = 0.85 vs. 0.81, P = 0.01), and LVV alone (AUC = 0.85 vs.0.82, P = 0.03). Combined ChP and hippocampal volumes significantly increased the ability to differentiate cerebral Aß42 changes and patients among AD dementia, MCI, and HCs groups compared with hippocampal volume alone (all P < 0.05). After correcting for age, sex, years of education, APOE ε4 status, eTIV, and hippocampal volume, ChP volume was associated with MMSE, MoCA, NPI, and ADL score at baseline, and rapid ChP volume enlargement was associated with faster deterioration in NPI scores with an average follow-up of 10.03 ± 4.45 months (all P < 0.05). CONCLUSIONS: ChP volume may be a novel neuroimaging marker associated with neurodegenerative changes and clinical AD manifestations. It could better detect the early stages of the AD and predict prognosis, and significantly enhance the differential diagnostic ability of hippocampus on the AD continuum.

Correspondence Between Vocal-Verbal Behavior and Go/No-Go Responses During the Successive Matching-to-Sample Procedure.

In the current study, eight college students were exposed to a successive matching-to-sample (S-MTS) procedure utilizing non-verbal auditory stimuli consisting of common sounds. During emergent relations tests, participants were asked to talk aloud, and their vocal-verbal statements were transcribed and categorized as class-consistent, class-inconsistent, or irrelevant. All participants met emergence criterion for symmetry and four did so for transitivity/equivalence. Analysis of vocal-verbal statements showed a positive correlation between class-consistent statements emitted by participants and correct selection responses during S-MTS tasks. Such results suggest possible verbal mediation during emergent relations tests.

Prospective longitudinal relations among frequent social media use, nicotine vaping and experiencing internalizing mental health problems.

AIMS: To compare four a priori rival mediated pathways of frequent social media use, electronic nicotine delivery systems (ENDS) use and internalizing mental health (MH) problems across five waves of nationally representative data. DESIGN, SETTING AND PARTICIPANTS: This was a longitudinal study using data drawn from waves 2-5 (October 2014-November 2019) of the Population Assessment of Tobacco and Health Study, a nationally representative cohort study spanning approximately 5 years, conducted in the United States. The analytical sample of participants included those who were aged 12-14 years at wave 2 and who provided data in subsequent waves until wave 4.5 (n = 4627, 69.7% were White and 51.4% were male). MEASUREMENTS: Frequent social media use (several times a day), ENDS use (past 30-day use) and internalizing MH problems (endorsed symptoms on four items in the past year) were dichotomized for analysis. FINDINGS: The weighted proportions of the three key variables increased over time. From wave 2 to wave 5, frequent social media use grew from 56.9 to 77.2%; internalizing MH problems from 18.9 to 29.0%; and ENDS use from 1.4 to 11.4%. In weighted logistic regressions using generalized linear mixed models with random effects, there was a significant within-person association between frequent social media use at time t and greater ENDS use at t + 1 [adjusted odds ratio (aOR) = 1.87; 95% confidence interval (CI) = 1.47, 2.37] and worsened internalizing MH problems at t + 1 (aOR = 1.19; 95% CI = 1.04, 1.37). A model-based causal mediation analysis and marginal structural models were fitted to estimate the average causal mediation effect. Among all four examined mediation pathways throughout the three constructs, partial mediation was observed, and all the pathways were significant for both boys and girls. Sex differences did not emerge in the examined prospective mediated pathways. CONCLUSIONS: Among youth in the United States, frequent social media use appears to mediate the prospective association between experiencing internalizing mental health problems and using electronic nicotine delivery systems.

Influence of anxious attachment on the relationship between primary emotions and substance-related addictive behaviors.

Objectives: To date there is no universally accepted model that describes the development of substance related addictive behavior. In order to address this gap, the study sought to examine whether the association between primary emotions and the inclination toward addictive behavior is mediated by an anxious attachment style. Methods: The total sample consisted of 900 German speaking non-clinical adults (age: M = 27; SD = 9.60; 71.6% female). Structural Equation Modeling (SEM) was applied to examine the connection between the primary emotions (SADNESS and ANGER), and the latent variables attachment anxiety and symptoms of addictive behavior. Results: Substance use symptomatology was correlated with higher attachment anxiety (r = 0.15), SADNESS (r = 0.15), and ANGER (r = 0.11). The effect of SADNESS on addictive behavior is mediated by attachment anxiety (p < 0.01) whereas ANGER had a direct effect on addictive behavior (p < 0.01). The final SEM explains 4% of the variance of addictive behaviors and 22% of attachment anxiety. Conclusion: Our findings suggest that both SADNESS and ANGER, along with attachment anxiety, are dispositions that contribute to the risk of engaging in addictive behavior. However, while ANGER directly influences addictive behavior, SADNESS acts through its impact on attachment anxiety.

Associations between capacity of cognitive control and sleep quality: a two-wave longitudinal study.

This longitudinal study explored the impact of the upper limit of cognitive control on the sleep quality of high school students. We collected data in two waves to examine four main variables: capacity of cognitive control (CCC), trait mindfulness, emotional distress and sleep quality. At the first time point (T1), trait mindfulness and emotional distress were measured by rating scales, and the CCC was evaluated by revised backward masking majority function task. Sleep quality was rated 5 months later (T2). The results indicated that: (1) the CCC was negatively correlated with trait mindfulness, and trait mindfulness was negatively correlated with emotional stress; (2) there was no simple mediation of either trait mindfulness or emotional distress in the relationship between CCC and sleep quality; (3) instead, the CCC was associated with poor sleep quality in a sequential mediation through trait mindfulness and then emotional stress. The research highlights the importance of trait mindfulness and emotional distress for addressing sleep problems in adolescents.

Sex hormone-binding globulin may explain sex differences for glucose homeostasis and incidence of type 2 diabetes: the KORA study.

Research has indicated that sex hormone-binding globulin (SHBG) is associated with glucose homeostasis and may play a role in the etiology of type 2 diabetes (T2D). While it is unclear whether SHBG may mediate sex differences in glucose control and subsequently, incidence of T2D. We used observational data from the German population-based KORA F4 study (n = 1937, mean age: 54 years, 41% women) and its follow-up examination KORA FF4 (median follow-up 6.5 years, n = 1387). T2D was initially assessed by self-report and validated by contacting the physicians and/ or reviewing the medical charts. Mediation analyses were performed to assess the role of SHBG in mediating the association between sex (women vs. men) and glucose- and insulin-related traits (cross-sectional analysis) and incidence of T2D (longitudinal analysis). After adjustment for confounders, (model 1: adjusted for age; model 2: model 1 + smoking + alcohol consumption + physical activity), women had lower fasting glucose levels compared to men (ß = -4.94 (mg/dl), 95% CI: -5.77, -4.11). SHBG levels were significantly higher in women than in men (ß = 0.47 (nmol/l), 95% CI:0.42, 0.51). Serum SHBG may mediate the association between sex and fasting glucose levels with a proportion mediated (PM) of 30% (CI: 22-41%). Also, a potential mediatory role of SHBG was observed for sex differences in incidence of T2D (PM = 95% and 63% in models 1 and 2, respectively). Our novel findings suggest that SHBG may partially explain sex-differences in glucose control and T2D incidence.

The association between rs6859 in NECTIN2 gene and Alzheimer's disease is partly mediated by pTau.

Introduction: Emerging evidence suggests a connection between vulnerability to infections and Alzheimer's disease (AD). The nectin cell adhesion molecule 2 (NECTIN2) gene coding for a membrane component of adherens junctions is involved in response to infection, and its single nucleotide polymorphism (SNP) rs6859 was significantly associated with AD risk in several human cohorts. It is unclear, however, how exactly rs6859 influences the development of AD pathology. The aggregation of hyperphosphorylated tau protein (pTau) is a key pathological feature of neurodegeneration in AD, which may be induced by infections, among other factors, and potentially influenced by genes involved in both AD and vulnerability to infections, such as NECTIN2. Materials and methods: We conducted a causal mediation analysis (CMA) on a sample of 708 participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI). The relationship between rs6859 and Alzheimer's disease (AD), with AD (yes/no) as the outcome and pTau-181 levels in the cerebrospinal fluid (CSF) acting as a mediator in this association, was assessed. Adjusted estimates from the probit and linear regression models were used in the CMA model, where an additive model considered an increase in dosage of the rs6859 A allele (AD risk factor). Results: The increase in dose of allele A of the SNP rs6859 resulted in about 0.144 increase per standard deviation (SD) of pTau-181 (95% CI: 0.041, 0.248, p<0.01). When included together in the probit model, the change in A allele dose and each standard deviation change in pTau-181 predicted 6.84% and 9.79% higher probabilities for AD, respectively. In the CMA, the proportion of the average mediated effect was 17.05% and was higher for the risk allele homozygotes (AA), at 19.40% (95% CI: 6.20%, 43.00%, p<0.01). The sensitivity analysis confirmed the evidence of a robust mediation effect. Conclusion: This study reported a new causal relationship between pTau-181 and AD. We found that the association between rs6859 in the NECTIN2 gene and AD is partly mediated by pTau-181 levels in CSF. The rest of this association may be mediated by other factors. Further research, using other biomarkers, is needed to uncover the remaining mechanisms of the association between the NECTIN2 gene and AD.

The association of physical activity and sedentary behavior with depression in US adults: NHANES 2007-2018.

Objectives: Depression is largely preventable, and strategies that can effectively suppress its development are imperative. We aimed to examine whether physical activity and sedentary behavior were associated with depression and explore the possible mediatory role of complete blood count in this association. Methods: In this cross-sectional study, data were integrated from the National Health and Nutrition Examination Study (2007-2018). Depression was defined using the Patient Health Questionnaire-9. The risk for depression, expressed as odds ratio (OR) and 95% confidence interval (CI), was quantified by survey-weighted logistic regression analyses. Results: A total of 31,204 respondents were analyzed. Significance was identified for all, except walking or bicycling per week, types of physical activity, and sedentary behavior. Per 1 standard deviation (SD) increment in metabolic equivalent of task (MET) of weekly vigorous recreational physical activity was associated with 31.3% decreased depression risk (adjusted OR: 0.687, 95% CI: 0.5663-0.840). Per 1 SD increment in sitting time can increase depression risk by 22.4% (adjusted OR: 1.224, 95% CI: 1.131-1.325). In subsidiary analyses, the association with depression was reinforced in respondents aged ≤65 years and those overweight or obese. Mediation analyses revealed significant effects for red blood cell (RBC) on total MET (19.4%) and moderate work-related physical activity (MWPA) (22.0%), and for red cell distribution wide (RCDW) on vigorous work-related physical activity (17.7%), moderate work-related physical activity (13.1%), total MET (11.2%), and sitting time (16.4%) (p < 0.01). Conclusion: Our findings indicate that more physical activity and less sitting time were associated with a lower likelihood of having depression among US adults, and this association was probably mediated by RBC and RCDW.

Low-grade systemic inflammation links heavy metal exposures to mortality: A multi-metal inflammatory index approach.

Certain heavy metals have been correlated to an elevated risk of inflammation-related diseases and mortality. Nevertheless, the intricate relationships between metal exposure, inflammation and mortality remain unknown. We included 3741 adults with measurements of ten urinary heavy metals in the National Health and Nutritional Examination Survey (NHANES) 2005-2010, followed up to December 31, 2019. Low-grade systemic inflammation was evaluated by various markers, including C-reactive protein (CRP) and ratios derived from regular blood tests. We assessed associations between heavy metal and all-cause mortality using multivariate COX regressions. Then we assessed the mediation effect of low-grade systemic inflammation on the associations via Sobel Test. To gauge the systemic inflammatory potential of the multi-metal mixture and its correlation with all-cause mortality, a Metal Mixture Inflammatory Index (MMII) was developed using reduced rank regression (RRR) models. The association between MMII and all-cause mortality was explored via multivariate COX regressions. Cadmium, antimony and uranium displayed positive associations with mortality, with hazard ratios (HR) ranging from 1.18 to 1.46 (all P-FDR < 0.05). Mediation analyses revealed that the associations between specific heavy metals (cadmium and antimony) and mortality risk were slightly mediated by the low-grade systemic inflammation markers, with mediation proportions ranging from 3.11 % to 5.38 % (all P < 0.05). MMII, the weighted sum of 9 heavy metals, significantly predicted platelet-to-lymphocyte ratio (PLR) and CRP (ß = 0.10 and 1.16, all P < 0.05), was positively associated with mortality risk (HR 1.28, 95 % CI 1.14 to 1.43). Exposure to heavy metals might increase all-cause mortality, partly mediated by low-grade systemic inflammation. MMII, designed to assess the potential systemic inflammatory effects of exposure to multiple heavy metals, was closely related to the all-cause mortality risk. This study introduces MMII as an approach to evaluating co-exposure and its potential health effects comprehensively.

Association between Life's Essential 8 and Infertility as Well as the Mediating Effects of Oxidative Stress and Inflammatory Factors Among U.S. Women Aged 18-45 Years.

Management of cardiovascular disease in pregnancy is important, yet the association between cardiovascular health and infertility is rarely reported. In this study, we aimed to explore the association between Life's Essential 8 (LE8), a novel cardiovascular health (CVH) measure, and infertility, and to investigate potential mediating mechanisms. This study investigated cross-sectional data from the 2013-2018 National Health and Nutrition Examination Survey. LE8 score (ranging from 0 to 100) was calculated as the unweighted average of eight CVH metrics. The association between LE8 and infertility was explored through weighted multiple logistic regression. Restricted cubic splines were used to explore nonlinear correlation. In addition, mediation analysis was conducted to investigate the role of oxidative stress and inflammatory markers systematically. After strict exclusion criteria, 1703 American women aged 18-45 years were included. After full adjustment, the LE8 score showed a negative correlation with infertility [per 1 SD increase, OR = 0.675, 95% CI: 0.553-0.824], with a linear dose-response relationship (non-linear P = 0.122). Similar linear negative correlations were found between health factor scores and infertility, with higher body mass index and glucose scores having a significantly lower risk of infertility. Stratified analyses showed a stronger inversed relationship between LE8 and infertility in younger populations. Moreover, mediation analysis revealed that uric acid concentration and lymphocyte count mediated the effect of LE8 on infertility (P < 0.05). LE8 and its subscale scores were linearly and negatively associated with infertility, which may be mediated in part through uric acid and lymphocyte count. Focusing on weight management and glycemic control can effectively reduce the risk of infertility.

Caregiver coping mediates the relationship between caregivers' understanding of dementia as terminal and their distress.

We assessed which coping strategies (problem-focused, emotion-focused, dysfunctional) mediate the association between caregivers' understanding of dementia as terminal and their distress. A total of 215 caregivers of community-dwelling persons with severe dementia were surveyed every 4 months over 3 years. A generalized structural equation model was used to test mediation. Caregivers who correctly understood dementia as terminal and those unsure (vs incorrect), experienced more distress (correct: ß [95% confidence interval (CI)]: 0.80 [0.00 to 1.60]; unsure: 0.95 [0.04 to 1.87]). Caregivers with correct understanding of dementia as terminal (vs incorrect) employed more dysfunctional (2.01 [0.60 to 3.42]) and problem-focused coping strategies (2.56 [0.08 to 5.05]). Although dysfunctional and problem-focused coping (associated with higher distress) mediated the positive association between caregivers' understanding that dementia is terminal and their distress, emotion-focused coping (associated with lower distress) did not offset this relationship. Results suggest that terminal illness disclosure to caregivers should be accompanied by interventions to promote emotion-focused coping strategies. Highlights Caregivers who understood dementia as terminal experienced more distress. Dysfunctional and problem-focused coping mediated the positive relationship between terminal illness understanding and caregiver distress. Emotion-focused coping did not offset this relationship.

How and when does proactive personality predict career adaptability? A study of the moderated mediation model.

In the present study, we explored the relationship between proactive personality and career adaptability to construct a cross-level moderated mediation model based on the conservation of resources (COR) theory. By conducting a time-lagged study involving three data collection points from 587 employees across 104 teams in China, we examined how and when proactive personality predicts employees' career adaptability using strengths use as a mediator and managerial coaching as boundary conditions. The results revealed that proactive personality predicted strengths use, which, in turn, influenced career adaptability, with managerial coaching moderating the indirect relationship between proactive personality and career adaptability. Consequently, our findings suggest that, in contexts where managerial coaching lacks guidance, facilitation, and inspiration, a proactive personality encourages employees to leverage their strengths, subsequently enhancing their career adaptability. Finally, we discuss the theoretical and practical implications of our findings, address limitations, and propose directions for future research.

Relationship between dietary inflammation index and frailty in patients with osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is a common chronic joint disease that significantly affects an individual's quality-of-life and frailty has become one of the common complications in OA patients as the disease progresses. The relationship between dietary patterns is not clear. METHODS: All participants are from the National Health and Nutrition Examination Survey (NHANES) and have been diagnosed with OA. The dietary inflammation index (DII) is calculated based on the dietary intake reported by the participants. Logistic regression analysis is used to investigate the relationship between DII and frailty. Restricted cubic splines are utilised to explore their nonlinear relationship. Mediation analysis is conducted to explore the role of inflammation in this relationship. RESULTS: A total of 2,530 OA patients were included in the study, with an average age of 64.46 (12.67) years. After adjusting for covariates, for each one standard deviation increase in DII, the risk of frailty increased by 15% (OR = 1.15, 95% CI = 1.03-1.28). Compared to patients with DII < -1, patients with DII > 1 had a significantly higher risk of frailty (OR = 1.50, 95% CI = 1.05-2.14). CONCLUSIONS: The findings of this study indicate a positive association between DII and the risk of frailty in OA patients. These results underscore the potential impact of dietary interventions in improving the quality-of-life for OA patients.

Association of dietary saturated fatty acid intake with depression: mediating effects of the dietary inflammation index.

Background: Diet and dietary inflammation play an important role in depression. The aim of this study was to assess the association of SFAs with depression risk and the mediating role of DII. Method: Among 22, 478 U.S. adults (≥ 20, years old) according to the National Health and Nutrition Examination Survey (NHANES), univariate logistic regression, and multivariate logistic regression were used to evaluate the association between dietary intake of SFAs and the risk of depression. Dietary inflammation levels were evaluated using the DII. Mediation analysis was used to investigate the risk of DII and depression. The nonlinear relationship between SFAs and depression was assessed using restricted cubic spline (RCS). Results: There was a significant difference in SFA 6.0 dietary intake between depression and non-depression individuals. After adjusting for potential confounders, multifactorial logistic regression results showed that SFA 8.0 (Q3 1.58 (1.09, 2.30), p-value = 0.017; Q4 1.55 (1.00, 2.42), p-value = 0.050) may increase the prevalence factor for depression, SFA 14.0 (Q3 0.67 (0.47, 0.94), p-value = 0.020) may decrease the risk of depression. There were sex and age differences in the effects of different subtypes of SFAs on depression. Dietary intake of SFA 12.0 content showed a nonlinear relationship with the risk of depression (p-value = 0.005). Furthermore, DII was recognized as a mediator of the association between SFAs and the risk of depression. Conclusion: The findings suggest that dietary intake of SFAs is associated with the risk of depression in relation to the chain length of SFAs, and this may be due to the mediating effect of DII.

Cerebrospinal Fluid Nitric Oxide Synthase is a Potential Mediator Between Cigarette Smoke Exposure and Sleep Disorders.

Objective: Cigarette smoking and low peripheral nitric oxide synthase (NOS) levels are strongly associated with sleep disorders. However, whether cerebrospinal fluid (CSF) NOS relates to sleep disorders and whether CSF NOS mediates the relationship between cigarette smoking and sleep disorders is unclear. Methods: We measured CSF levels of total NOS (tNOS) and its isoforms (inducible NOS [iNOS] and constitutive NOS [cNOS]) in 191 Chinese male subjects. We applied the Pittsburgh Sleep Quality Index (PSQI). Results: The PSQI scores of active smokers were significantly higher than those of non-smokers, while CSF tNOS, iNOS, and cNOS were significantly lower (all p < 0.001). CSF tNOS, iNOS, and cNOS were negatively associated with PSQI scores in the general population (all p < 0.001). Mediation analysis suggested that CSF tNOS, iNOS, and cNOS mediate the relationship between smoking and PSQI scores, and the indirect effect accounted for 78.93%, 66.29%, and 81.65% of the total effect, respectively. Conclusion: Cigarette smoking is associated with sleep disorders. Active smokers had significantly lower CSF levels of tNOS, iNOS, and cNOS. Furthermore, tNOS, iNOS, and cNOS mediate the relationship between cigarette smoking and sleep quality. This study provides insights into how cigarette smoke affects sleep disorders.