AIM:To explore the causal relationship between several possible behavioral factors and high myopia(HM)using multivariable Mendelian randomization(MVMR)approach and to find the mediators among them with mediation analy...AIM:To explore the causal relationship between several possible behavioral factors and high myopia(HM)using multivariable Mendelian randomization(MVMR)approach and to find the mediators among them with mediation analysis.METHODS:The causal effects of several behavioral factors,including screen time,education time,time spent outdoors,and physical activity,on the risk of HM using univariable Mendelian randomization(MR)and MVMR analyses were first assessed.Genome-wide association study summary statistics of serum metabolites were also used in mediation analysis to determine the extent to which serum metabolites mediate the effects of behavioral factors on HM.RESULTS:MR analyses indicated that both increased time spent outdoors and a higher frequency of moderate physical activity significantly reduced the risk of HM.Further MVMR analysis confirmed that moderate physical activity independently contributed to a lower risk of HM.Additionally,MR analyses identified 13 serum metabolites significantly associated with HM,of which 12 were lipids and one was an amino acid derivative.Mediation analysis revealed that six lipid metabolites mediated the protective effects of moderate physical activity on HM,with the highest mediation proportion observed for 1-(1-enyl-palmitoyl)-GPC(p-16:0;30.83%).CONCLUSION:This study suggests that in addition to outdoor time,moderate physical activity habits may have an independent protective effect against HM and pointed to lipid metabolites as priority targets for the prevention due to low physical activity.These results emphasize the importance of physical activity and metabolic health in HM and underscore the need for further study of these complex associations.展开更多
While a healthy lifestyle is known to reduce the risk of stroke,the extent to which blood pressure(BP)mediates this association remains unclear.The present study aimed to quantify the mediating role of BP in the assoc...While a healthy lifestyle is known to reduce the risk of stroke,the extent to which blood pressure(BP)mediates this association remains unclear.The present study aimed to quantify the mediating role of BP in the association between combined lifestyle factors and stroke incidence.Using data from 51929 participants free of major cardiovascular diseases or cancer at baseline,we employed structural equation modeling to assess the mediating effects of systolic(SBP)and diastolic(DBP)blood pressure.During the follow-up,2811 incident stroke cases were identified.A healthy lifestyle was significantly associated with a reduced risk of stroke,with SBP mediating 44.70%(β=-0.0014,95%confidence interval[CI]:-0.0016 to-0.0012)and DBP mediating 37.81%(β=-0.0012,95%CI:-0.0015 to-0.0009)of this association.The mediating effects were attenuated but remained significant for ischemic stroke(SBP:33.21%;DBP:27.24%).In conclusion,approximately two-fifths of the protective association between a healthy lifestyle and stroke may be mediated by BP.These findings suggest that BP control may serve as an important early indicator for evaluating the effectiveness of lifestyle interventions in reducing stroke risk.展开更多
BACKGROUND Depression is a leading global health concern with high suicide rates and recurrence.Cognitive models suggest that mental pain and automatic thoughts are central to depression's impact.The hypothesis is...BACKGROUND Depression is a leading global health concern with high suicide rates and recurrence.Cognitive models suggest that mental pain and automatic thoughts are central to depression's impact.The hypothesis is that self-compassion will be negatively associated with mental pain,mediated by automatic thoughts.AIM To determine the mediating role of automatic thoughts in the relationship between self-compassion and mental pain in individuals with depression.METHODS This cross-sectional study included 389 inpatients with depression from Tianjin Anding Hospital.Participants completed the Self-Compassion Scale-Chinese Version(SCS-C),Automatic Thought Questionnaire(ATQ),and Orbach&Mikulincer Mental Pain Scale-Chinese Version(OMMP).Data were analyzed using Pearson correlations,multiple linear regressions,and mediation analysis.RESULTS The SCS-C total score was 68.95±14.89,ATQ was 87.02±28.91,and OMMP was 129.01±36.74.Correlation analysis showed mental pain was positively associated with automatic thoughts(r=0.802,P<0.001)and negatively with selfcompassion(r=-0.636,P<0.001).Regression analysis indicated automatic thoughts(β=0.623,P<0.001)and self-compassion(β=-0.301,P<0.001)significantly predicted mental pain.Mediation analysis confirmed automatic thoughts partially mediated the relationship between self-compassion and mental pain(ab=-0.269,95%CI:-0.363 to-0.212).CONCLUSION Self-compassion is inversely related to mental pain in depression,with automatic thoughts playing a mediating role.These findings suggest potential therapeutic targets for alleviating mental pain in depressed patients.展开更多
Background We aimed to investigate the relationships between metabolic syndrome(MetS)and its severity score(Metsss)with asymptomatic intracranial arterial stenosis(aICAS)while also assessing the additional effect of h...Background We aimed to investigate the relationships between metabolic syndrome(MetS)and its severity score(Metsss)with asymptomatic intracranial arterial stenosis(aICAS)while also assessing the additional effect of high-sensitivity C reactive protein(hsCRP).Methods This cross-sectional study included 2390 individuals who underwent health examinations at our centre from June 2019 to August 2023.Participants received physical examinations,laboratory tests and magnetic resonance angiography evaluations.MetS was defined by the modified acknowledged criteria and quantified by Metsss.Logistic regression,interaction analysis and mediation analysis were employed.Results Among the 2390 participants,135(5.65%)had aICAS,and 726(30.40%)had MetS.After adjusting for confounders,MetS was significantly associated with aICAS(OR:1.68,95%CI:1.16 to 2.43,p=0.006).The prevalence of aICAS increased significantly from 3.6%to 8.6%as the number of MetS components increased.Higher quartiles of Metsss also significantly increased aICAS risk(P for trend<0.001).After multivariable adjustment,MetS(p=0.001)and elevated Metsss(p<0.001)were only associated with posterior circulation aICAS(vs anterior).Furthermore,participants with both MetS and elevated hsCRP levels had a greater risk for aICAS(OR:2.32,95%CI:1.36 to 3.96,p=0.002).hsCRP mediated the association between MetS and alCAS in participants≤65 years old.Conclusions MetS and Metsss were independently associated with the risk of aICAS.The mediating effect of hsCRP on the relationship between MetS and aICAS appears to be age-dependent.These findings offer valuable insights into clinical decision making of aICAS and further improve the primary stroke prevention.展开更多
Hexavalent chromium and its compounds are prevalent pollutants,especially in the work environment,pose a significant risk for multisystem toxicity and cancers.While it is known that chromium accumulation in the liver ...Hexavalent chromium and its compounds are prevalent pollutants,especially in the work environment,pose a significant risk for multisystem toxicity and cancers.While it is known that chromium accumulation in the liver can cause damage,the dose-response relationship between blood chromium(Cr)and liver injury,as well as the possible potential toxic mechanisms involved,remains poorly understood.To address this,we conducted a follow-up study of 590 visits from 305 participants to investigate the associations of blood Cr with biomarkers for liver injury,including serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),and direct bilirubin(DBIL),and to evaluate the mediating effects of systemic inflammation.Platelet(PLT)and the platelet-to-lymphocyte ratio(PLR)were utilized as biomarkers of systemic inflammation.In the linear mixed-effects analyses,each 1-unit increase in blood Cr level was associated with estimated effect percentage increases of 0.82%(0.11%,1.53%)in TBIL,1.67%(0.06%,3.28%)in DBIL,0.73%(0.04%,1.43%)in ALT and 2.08%(0.29%,3.87%)in AST,respectively.Furthermore,PLT mediated 10.04%,11.35%,and 10.77%increases in TBIL,DBIL,and ALT levels induced by chromate,respectively.In addition,PLR mediated 8.26%and 15.58%of the association between blood Cr and TBIL or ALT.These findings shed light on the mechanisms underlying blood Cr-induced liver injury,which is partly due to worsening systemic inflammation.展开更多
AIM:To study the causal relationship between obesityrelated anthropometric traits and myopia and the mediating role of educational attainment(EA).METHODS:Univariable Mendelian randomization(UVMR)was performed to evalu...AIM:To study the causal relationship between obesityrelated anthropometric traits and myopia and the mediating role of educational attainment(EA).METHODS:Univariable Mendelian randomization(UVMR)was performed to evaluate the causal association between body mass index(BMI),height,waist-hip ratio(WHR,adjusted for BMI),and mean spherical equivalent(MSE).BMI was divided into fat and fat-free mass and included in multivariable Mendelian randomization(MVMR)to explore the roles of different BMI components in the causal relationship between BMI and MSE.A mediation analysis based on two-step Mendelian randomization(MR)was carried out.Specifically,UVMR was conducted to estimate the causal effect of BMI on EA.The direct effect of EA on MSE was estimated from MVMR.The mediation effect of EA in the BMI-EA-MSE model was calculated by the product of coefficients method.Expression quantitative trait loci(eQTL)-MR,reverse MR,and Linkage Disequilibrium Score Regression(LDSC)were performed to assess the robustness.RESULTS:Genetically predicted higher BMI had a positive total effect on MSE(βIVW=0.26 D,95%CI=0.14 to 0.37 D,P<0.001),whereas there was no significant association between height,WHR,and MSE.Fat mass was found to play a significant role in the effect of body mass on MSE(βIVW=0.50 D,95%CI=0.21 to 0.78 D,P=0.001),but there was no significant association between fat-free mass and MSE.The causal effect of BMI on EA was-0.14(95%CI=-0.16 to-0.11,P<0.001),and the direct effect of EA on MSE was-0.63 D(95%CI=-0.81 to-0.44 D,P<0.001).The mediating effect of EA in the BMI-EA-MSE model was 0.09 D(95%CI=0.06 to 0.12 D),with a mediation proportion of 33%(95%CI=22.1%to 44.6%).No reverse causal associations were detected except for BMI on EA.The results of eQTL-MR and LDSC were consistent with each MR analysis.CONCLUSION:Genetically predicted higher BMI decreases the degree of myopia with a 33%mediation proportion by EA,and fat mass provides a dominant protective role in body mass-myopia.As a supplement to previous observational studies,it provides strong evidence for the relationship between anthropometric traits and refractive errors and offers a theoretical basis for future measures to prevent and control myopia.展开更多
BACKGROUND Education,cognition,and intelligence are associated with cholelithiasis occurrence,yet which one has a prominent effect on cholelithiasis and which cardiometabolic risk factors mediate the causal relationsh...BACKGROUND Education,cognition,and intelligence are associated with cholelithiasis occurrence,yet which one has a prominent effect on cholelithiasis and which cardiometabolic risk factors mediate the causal relationship remain unelucidated.AIM To explore the causal associations between education,cognition,and intelligence and cholelithiasis,and the cardiometabolic risk factors that mediate the associations.METHODS Applying genome-wide association study summary statistics of primarily European individuals,we utilized two-sample multivariable Mendelian randomization to estimate the independent effects of education,intelligence,and cognition on cholelithiasis and cholecystitis(FinnGen study,37041 and 11632 patients,respectively;n=486484 participants)and performed two-step Mendelian randomization to evaluate 21 potential mediators and their mediating effects on the relationships between each exposure and cholelithiasis.RESULTS Inverse variance weighted Mendelian randomization results from the FinnGen consortium showed that genetically higher education,cognition,or intelligence were not independently associated with cholelithiasis and cholecystitis;when adjusted for cholelithiasis,higher education still presented an inverse effect on cholecystitis[odds ratio:0.292(95%CI:0.171-0.501)],which could not be induced by cognition or intelligence.Five out of 21 cardiometabolic risk factors were perceived as mediators of the association between education and cholelithiasis,including body mass index(20.84%),body fat percentage(40.3%),waist circumference(44.4%),waist-to-hip ratio(32.9%),and time spent watching television(41.6%),while time spent watching television was also a mediator from cognition(20.4%)and intelligence to cholelithiasis(28.4%).All results were robust to sensitivity analyses.CONCLUSION Education,cognition,and intelligence all play crucial roles in the development of cholelithiasis,and several cardiometabolic mediators have been identified for prevention of cholelithiasis due to defects in each exposure.展开更多
This study utilizes mediation analysis and bootstrapping to analyze the mediating effect of capital structure on the association between managerial ability and firm performance.The dataset consists of 6384 firm-year o...This study utilizes mediation analysis and bootstrapping to analyze the mediating effect of capital structure on the association between managerial ability and firm performance.The dataset consists of 6384 firm-year observations from the Taiwan Residents electronics industry during 2005–2018.Our results indicate that(1)low(high)levels of debt are likely observed in firms with CEOs with high(low)ability,(2)managerial ability positively affects firm performance,and(3)capital structure mediates the positive relationship between managerial ability and firm performance.Overall,the findings may have limited generalizability due to the specific sample characteristics and provide convincing support for the importance of capital structure as a mediator in the managerial ability-firm performance nexus.Specifically,this study highlights the need for examining the effect of managerial ability on firm performance through a mediator.展开更多
Mendelian randomization(MR)is widely used in causal mediation analysis to control unmeasured confounding effects,which is valid under some strong assumptions.It is thus of great interest to assess the impact of violat...Mendelian randomization(MR)is widely used in causal mediation analysis to control unmeasured confounding effects,which is valid under some strong assumptions.It is thus of great interest to assess the impact of violations of these MR assumptions through sensitivity analysis.Sensitivity analyses have been conducted for simple MR-based causal average effect analyses,but they are not available for MR-based mediation analysis studies,and we aim to fill this gap in this paper.We propose to use two sensitivity parameters to quantify the effect due to the deviation of the IV assumptions.With these two sensitivity parameters,we derive consistent indirect causal effect estimators and establish their asymptotic propersties.Our theoretical results can be used in MR-based mediation analysis to study the impact of violations of MR as-sumptions.The finite sample performance of the proposed method is illustrated through simulation studies,sensitivity ana-lysis,and application to a real genome-wide association study.展开更多
This study examines how controlling shareholders influence firm performance through the mediating role of firm efficiency in transforming inputs into outputs.To achieve this objective,it conducts a mediation analysis ...This study examines how controlling shareholders influence firm performance through the mediating role of firm efficiency in transforming inputs into outputs.To achieve this objective,it conducts a mediation analysis with 5,000 bootstraps on a dataset of 2,849 firm-year observations of publicly listed firms in Malaysia from 2009 to 2019.The findings reveal a positive relationship between controlling shareholdings and firm performance,with both total and indirect effects having this positive relationship.Moreover,while controlling shareholdings improve firm performance,firm efficiency partially mediates this relationship.Thus,improved firm efficiency plays a critical role in understanding the relationship between governance by controlling shareholders and enhanced firm performance.In summary,this study contributes to the existing literature by expanding our understanding of the complex relationship between controlling shareholdings,firm efficiency,and firm performance.In addition,the findings shed light on the importance of indirect channels in shaping organizational outcomes.As such,this study provides a valuable direction for future research in this area.展开更多
Objective:Gut microbiota(GM)and blood metabolites are associated with the development of urticaria,yet their specific causal relationships in East Asian populations remain unclear.This study aims to elucidate the caus...Objective:Gut microbiota(GM)and blood metabolites are associated with the development of urticaria,yet their specific causal relationships in East Asian populations remain unclear.This study aims to elucidate the causal and mediating relationships among GM,blood metabolites,and urticaria in East Asians using Mendelian randomization(MR)analysis.Methods:Summary-level statistics for 500 GM taxa,112 blood metabolites,and urticaria were obtained from publicly available Genome-Wide Association Studies(GWAS)datasets.Bidirectional MR analyses were performed to examine causal associations among the GM,blood metabolites,and urticaria.The inverse variance weighted(IVW)method served as the primary analytical approach,supplemented by MR-Egger,weighted median,simple mode,and weighted mode methods.Sensitivity analyses included heterogeneity tests,horizontal pleiotropy assessments,and leave-one-out analyses.Mediation analysis was conducted to evaluate the potential mediating effects of blood metabolites on the causal pathways between GM and urticaria.Results:MR analyses identified 12 GM taxa exhibiting significant causal effects on urticaria susceptibility.Nine taxa,such as MF0017_galactose_degradation(OR=1.461,95%CI 1.098 to 1.944,P=0.009),were associated with increased urticaria risk.Three taxa,such as MF0001_arabinoxylan_degradation(OR=0.846,95%CI 0.737 to 0.973,P=0.019),showed protective effects with increased abundance.Additionally,6 blood metabolites demonstrated causal associations with urticaria.Notably,the risk of developing urticaria increases with rising fasting plasma glucose(FPG)levels(OR=1.971,95%CI 1.089 to 3.567,P=0.025).Mediation analysis further demonstrated that FPG partially mediated the protective effect of MF0001_arabinoxylan_degradation on urticaria,accounting for 11.30%of the total effect.Conclusion:This study has delineated specific GM taxa and blood metabolites that hold causal relevance to urticaria in East Asian populations.Notably,arabinogalactan degradation potentially mitigates urticaria risk via reducing FPG concentrations,offering genetic evidence to support therapeutic strategies targeting GM modulation and glucose regulation.展开更多
BACKGROUND Cervical cancer survivors of childbearing age often face heightened reproductive anxiety due to the direct impact of the disease and its treatments on fertility.This anxiety may exacerbate psychological bur...BACKGROUND Cervical cancer survivors of childbearing age often face heightened reproductive anxiety due to the direct impact of the disease and its treatments on fertility.This anxiety may exacerbate psychological burdens,including depressive symptoms and fear of recurrence,significantly impacting quality of life.AIM To examine whether reproductive concerns partially mediate the relationship between depressive symptoms and fear of recurrence in cervical cancer patients of childbearing age.METHODS Utilizing a cross-sectional design with convenience sampling,208 eligible cervical cancer patients(aged 18-45 years,stable condition,and aware of diagnosis)from three tertiary hospitals completed validated questionnaires:The Reproductive Concerns After Cancer Scale,Patient Health Questionnaire-9,and Fear of Cancer Recurrence Questionnaire.Structural equation modeling was used to assess the mediating role of reproductive concerns in the relationship between depression and fear of recurrence.RESULTS Reproductive concerns demonstrated significant positive correlations with depression(r=0.477,P<0.001)and fear of recurrence(r=0.426,P<0.001).Structural equation modeling analysis revealed that reproductive concerns acted as a significant partial mediator between depression and fear of recurrence.The indirect effect via reproductive concerns was significant(β_indirect=0.152,P<0.001),accounting for 28.1% of the total effect of depression on fear of recurrence.CONCLUSION Identified path reveals fertility anxiety links depression to recurrence fear.Targeted psych interventions for repro concerns may ease both in childbearing cervical cancer survivors.展开更多
This letter critically examines a recent study by Zhang et al investigating the mediating role of overweight in the association between depression and new-onset diabetes among middle-aged and older adults.The study pr...This letter critically examines a recent study by Zhang et al investigating the mediating role of overweight in the association between depression and new-onset diabetes among middle-aged and older adults.The study provides com-pelling evidence that overweight mediates approximately 61%of this relationship,suggesting that depression may contribute to diabetes by influencing behaviors that lead to weight gain.This aligns with the understanding that depression can impact appetite regulation and physical activity.While the study employs a longitudinal design and robust statistical methods,limitations such as reliance on self-reported data and body mass index measurements warrant consideration.This analysis emphasizes the need for integrated interventions that address both mental and metabolic health for effective diabetes prevention.Future research should further explore the interplay of lifestyle factors,biological pathways,and social determinants in the development of this complex relationship.Ultimately,an integrated approach targeting both behavioral and biological components is crucial for the prevention and management of new-onset diabetes.展开更多
Anemia is still prevalent among low and middle-income countries,posing serious family and social burdens.However,scarce studies provided evidence for real-world exposure to polycyclic aromatic hydrocarbons(PAHs)and an...Anemia is still prevalent among low and middle-income countries,posing serious family and social burdens.However,scarce studies provided evidence for real-world exposure to polycyclic aromatic hydrocarbons(PAHs)and anemia among pregnant women,as well as involved biological mechanisms.So,we conducted this study including 1717 late pregnant women fromZunyi Birth Cohort and collected urine samples for PAHs metabolites detection.Logistic regression and restricted cubic spline regression were used to examine exposuredisease risks and dose-response relationships.We conducted Bayesian kernel machine regression,weighted quantile sum regression,and quantile g-computation regression to fit the joint impacts of multiple PAHs in the real-world scenario on hypocalcemia and anemia.Results showed single exposure to 2-OHNap,2-OHFlu,9-OHFlu,1-OHPhe,2-OHPhe,3-OHPhe,and 1-OHPyr(all P-trend<0.05)increased the risks of hypocalcemia and anemia.Moreover,PAHs mixture was significantly related to higher risks of hypocalcemia and anemia,with 3-OHPhe and 1-OHPyr identified as their major drivers,respectively.Importantly,hypocalcemia served as a significant biological mechanism responsible for PAHs and anemia.Our findings suggest that individual and joint exposure to PAHs during late pregnancy elevate the anemia risk,and calcium supplementation might be a low-cost intervention target for reducing the PAHs-related impairment on anemia for pregnant women.展开更多
Objective To identify whether metabolic status mediates the associations between frailty and mortality and incident cardiovascular disease(CVD),and to assess of interactive or joint relationships between frailty and m...Objective To identify whether metabolic status mediates the associations between frailty and mortality and incident cardiovascular disease(CVD),and to assess of interactive or joint relationships between frailty and metabolic status on these outcomes.Methods In this prospective cohort study of 456,445 UK Biobank participants,frailty was assessed using five phenotype criteria.Metabolic status was scored(0–4)based on central obesity,hypertension,hyperglycemia,and dyslipidemia.Multivariable-adjusted Cox regression models were used to assess the associations between frailty and mortality and incident CVD.Results During a median follow-up of 13.8 years for mortality and 13.6 years for CVD,30,907 deaths(7,467 CVD-related)and 37,115 incident CVD cases occurred.Frailty was associated with higher risks of all-cause mortality(hazard ratio[HR],2.41;95%confidence interval[CI],2.31–2.51),CVD mortality(HR,2.64;95%CI,2.43–2.87),and incident CVD(HR,1.83;95%CI,1.75–1.91),compared with non-frail individuals.Metabolic status mediated 8.7%,16.1%,and 16.4%of these associations,respectively.Frailty and metabolic status interacted multiplicatively for all-cause mortality(P-value for interaction<0.001)and additively for CVD mortality[relative excess risk due to interaction(RERI),1.78;95%CI,0.88–2.68]and incident CVD(RERI,0.60;95%CI,0.33–0.86).Joint exposure to frailty and three to four metabolic disorders conferred 3.34-,6.32-,and 3.30-fold risks of all-cause mortality,CVD mortality,and incident CVD,respectively,compared with metabolically healthy non-frail individuals.Conclusion This study highlights the need for integrated management strategies targeting both frailty and metabolic conditions to mitigate cardiovascular and mortality risks.展开更多
The associations of volatile organic compounds(VOCs)exposure with short sleep duration(SSD)have rarely been studied.We aimed to evaluate the correlation between VOC exposure and SSD risk,while also exploring the poten...The associations of volatile organic compounds(VOCs)exposure with short sleep duration(SSD)have rarely been studied.We aimed to evaluate the correlation between VOC exposure and SSD risk,while also exploring the potential mediating influence of depressive symptoms.Blood concentrations of seven VOCs,namely benzene,toluene,ethylbenzene,m-/p-xylene,o-xylene,styrene(collectively known as BTEXS),and 1,4-dichlorobenzene,were analyzed in 2905 U.S.adults.Weighted logistic regression,quantile-based g-computation(QGC),and weighted quantile sum(WQS)regression were employed to investigate associations between selected VOCs and SSD risk.Mediation analyses were conducted to explore the potential mediating effects of depressive symptoms on these relationships.Increased blood levels of BTEXS were positively correlated with SSD risk,with odds ratios(OR)ranging from 1.130 to 1.212(all P<0.05).A nonlinear association between toluene concentration and SSD risk was observed(P for nonlinearity=0.028).Both QGC and WQS analyses indicated a positive association between co-exposure to VOCs and SSD,with styrene showing the highest positive weights(QGC:OR=1.313,95%confidence interval(CI):1.038–1.660;WQS:OR=1.386,95%CI:1.111–1.731).Furthermore,BTEXS exposure was positively linked to depressive symptoms,which in turn were significantly associated with SSD risk.Mediation analyses revealed that depressive symptoms partially mediated the relationships between individual and mixed VOCs and SSD risk,with mediation proportions ranging from 15.87%to 20.54%(all P<0.05).These findings indicated that exposure to VOCs increased SSD risk,with depressive symptoms playing a partial mediating role.展开更多
Objective:Chronic noncommunicable conditions are a major driver of poor health in low-and middle-income countries,yet the mental health pathways through which these illnesses shape perceived health remain underexamine...Objective:Chronic noncommunicable conditions are a major driver of poor health in low-and middle-income countries,yet the mental health pathways through which these illnesses shape perceived health remain underexamined.This study investigates whether recent mental well-being—measured using the World Health Organization Five-Item Well-Being Index(WHO-5)—mediates the association between chronic illness and self-rated health(SRH)among Egyptian adults aged 32–65.Methods:This study uses nationally representative data from the 2023 Egypt Labor Market Panel Survey(n=23,044)and estimates survey-weighted Ordinary Least Squares models predicting SRH(1=very good/excellent to 5=very bad).The key independent variable is chronic illness status.Mediation analysis is conducted using the Sobel–Goodman method with 1000 bootstrap replicates.All models adjust for sociodemographic covariates including age,sex,education,marital status,and regional residence.Results:Chronic illness is associated with significantly worse SRH(β=0.59,standard error[SE]=0.02,P<0.001).When mental well-being is added to the model,the chronic illness coefficient declines to 0.50(SE=0.02,P<0.001),and WHO-5 is independently associated with better SRH(β=-0.22,SE=0.01,P<0.001).The indirect effect via WHO-5 is 0.08(SE=0.01,P<0.001),indicating that 14.2%of the total association is mediated through recent psychological well-being.Conclusion:Although most of the self-rated health disadvantage linked to chronic illness flows through somatic and functional channels,mental well-being accounts for a meaningful share.Incorporating WHO-5 screening and stepped referral into chronic care could improve subjective health outcomes in Egypt.Mental health integration should be viewed as a critical component of equitable noncommunicable disease strategies.展开更多
Background Coronary artery calcification(CAC),a hallmark of atherosclerosis,paradoxically associates with reduced cardiovascular risk under statin therapy despite accelerated calcification progression,prompting this s...Background Coronary artery calcification(CAC),a hallmark of atherosclerosis,paradoxically associates with reduced cardiovascular risk under statin therapy despite accelerated calcification progression,prompting this study to explore CAC metrics as potential mediators between statin use and major adverse cardiovascular events(MACE).Methods Clinical data of 246 hospitalized patients who underwent coronary computed tomography angiography(CCTA)at Guangdong Provincial People's Hospital from January 2023 to June 2023 were retrospectively analyzed.Linear regression was used to evaluate the relationship between statin use and CAC parameters.Multivariable Poisson regression models were applied to explore the associations of statin use and CAC parameters with MACE risk.A mediation analysis was performed to assess the role of CAC parameters in the statin-MACE relationship.Results Statin use was independently associated with increased calcification score(β=0.648,P<0.001),CAC volume(β=0.623,P<0.001),and calcified plaque proportion(β=0.606,P=0.002).Multivariable Poisson regression indicated that statin use significantly reduced MACE risk[incidence rate ratio(IRR):0.33,P=0.018],whereas calcification score(IRR:2.63,P=0.026)and CACvolume(IRR:2.66,P=0.044)were associated with elevated MACE risk;Calcified plaque proportion showed no significant association.Mediation analysis revealed that calcification score(β=0.035,P=0.021)and CAC volume(β=0.023,P=0.018)exerted masking effects,while calcified plaque proportion had no mediating role.Conclusions Calcification score and CACvolume demonstrated limited masking effects in the association between statin use and MACE.展开更多
To investigate how spatial heterogeneity affects the so-called“resource curse”in China,we combine a careful selection of indicators with the concept of resource industry spatial agglomeration(RISA)as a proxy for res...To investigate how spatial heterogeneity affects the so-called“resource curse”in China,we combine a careful selection of indicators with the concept of resource industry spatial agglomeration(RISA)as a proxy for resource abundance and dependency.To address RISA heterogeneity among regions,those lacking a spatial concentration in non-resource industries are excluded from the analysis.We then develop an econometric model of regional economic growth(REG)using RISA.To further investigate the impact mechanisms of RISA and other factors influencing REG,we use the feasible generalized least squares(FGLS)method and the system generalized method of moments(SGMM).Conducting a stepwise regression analysis,we systematically examine the effect of the resource curse at the regional level from a RISA perspective.Our key findings are as follows:①Fifteen provinces in China exhibit RISA,and their level of economic development is significantly lower than that of provinces without a spatial agglomeration of resource industries.②RISA and REG exhibit a“U-shaped”relationship,characterized initially by suppression followed by promotion.③In terms of transmission mechanisms,investments in material and human capital,the degree of openness to foreign trade,and residents’savings rate all suppress RISA,while investments in technological innovation,development of the private economy and the manufacturing industry,and government intervention can promote spatial agglomeration of resource industries.展开更多
Objective To study the importance of digital economy to promote the innovation development of enterprises under the background of the era of information technology reform.Methods The maximum entropy method was used to...Objective To study the importance of digital economy to promote the innovation development of enterprises under the background of the era of information technology reform.Methods The maximum entropy method was used to measure the comprehensive level of digital economy development at provincial level.Besides,the impact of digital economy on the innovation performance of pharmaceutical industry was investigated empirically by using A-share pharmaceutical companies listed in China from 2013 to 2020 as a research sample,and the mediating mechanism of R&D investment and financing constraints on the impact was examined.Results and Conclusion It is found that digital economy is significantly and positively related to the innovation performance of enterprises.The mechanism test shows that digital economy improves innovation performance through the expansion effect of R&D investment and alleviating financing constraints.In the context that digital economy has become a new driving force for enterprise innovation,the combination of digital economy and real economy should be actively promoted,R&D investment in pharmaceutical enterprises should be increased,and financing channels should be broadened.展开更多
基金Supported by the Central High Level Hospital Clinical Research Funding(No.BJ-2024-089).
文摘AIM:To explore the causal relationship between several possible behavioral factors and high myopia(HM)using multivariable Mendelian randomization(MVMR)approach and to find the mediators among them with mediation analysis.METHODS:The causal effects of several behavioral factors,including screen time,education time,time spent outdoors,and physical activity,on the risk of HM using univariable Mendelian randomization(MR)and MVMR analyses were first assessed.Genome-wide association study summary statistics of serum metabolites were also used in mediation analysis to determine the extent to which serum metabolites mediate the effects of behavioral factors on HM.RESULTS:MR analyses indicated that both increased time spent outdoors and a higher frequency of moderate physical activity significantly reduced the risk of HM.Further MVMR analysis confirmed that moderate physical activity independently contributed to a lower risk of HM.Additionally,MR analyses identified 13 serum metabolites significantly associated with HM,of which 12 were lipids and one was an amino acid derivative.Mediation analysis revealed that six lipid metabolites mediated the protective effects of moderate physical activity on HM,with the highest mediation proportion observed for 1-(1-enyl-palmitoyl)-GPC(p-16:0;30.83%).CONCLUSION:This study suggests that in addition to outdoor time,moderate physical activity habits may have an independent protective effect against HM and pointed to lipid metabolites as priority targets for the prevention due to low physical activity.These results emphasize the importance of physical activity and metabolic health in HM and underscore the need for further study of these complex associations.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.82192900,82192901,82192904,81390540,and 91846303 to L.L.)the National Key Research and Development Program of China(Grant No.2016YFC0900500 to Y.G.)the Kadoorie Charitable Foundation in Hong Kong,and the Wellcome Trust in the UK(Grant/Award Nos.088158/Z/09/Z,104085/Z/14/Z,and 202922/Z/16/Z to Z.C.).
文摘While a healthy lifestyle is known to reduce the risk of stroke,the extent to which blood pressure(BP)mediates this association remains unclear.The present study aimed to quantify the mediating role of BP in the association between combined lifestyle factors and stroke incidence.Using data from 51929 participants free of major cardiovascular diseases or cancer at baseline,we employed structural equation modeling to assess the mediating effects of systolic(SBP)and diastolic(DBP)blood pressure.During the follow-up,2811 incident stroke cases were identified.A healthy lifestyle was significantly associated with a reduced risk of stroke,with SBP mediating 44.70%(β=-0.0014,95%confidence interval[CI]:-0.0016 to-0.0012)and DBP mediating 37.81%(β=-0.0012,95%CI:-0.0015 to-0.0009)of this association.The mediating effects were attenuated but remained significant for ischemic stroke(SBP:33.21%;DBP:27.24%).In conclusion,approximately two-fifths of the protective association between a healthy lifestyle and stroke may be mediated by BP.These findings suggest that BP control may serve as an important early indicator for evaluating the effectiveness of lifestyle interventions in reducing stroke risk.
文摘BACKGROUND Depression is a leading global health concern with high suicide rates and recurrence.Cognitive models suggest that mental pain and automatic thoughts are central to depression's impact.The hypothesis is that self-compassion will be negatively associated with mental pain,mediated by automatic thoughts.AIM To determine the mediating role of automatic thoughts in the relationship between self-compassion and mental pain in individuals with depression.METHODS This cross-sectional study included 389 inpatients with depression from Tianjin Anding Hospital.Participants completed the Self-Compassion Scale-Chinese Version(SCS-C),Automatic Thought Questionnaire(ATQ),and Orbach&Mikulincer Mental Pain Scale-Chinese Version(OMMP).Data were analyzed using Pearson correlations,multiple linear regressions,and mediation analysis.RESULTS The SCS-C total score was 68.95±14.89,ATQ was 87.02±28.91,and OMMP was 129.01±36.74.Correlation analysis showed mental pain was positively associated with automatic thoughts(r=0.802,P<0.001)and negatively with selfcompassion(r=-0.636,P<0.001).Regression analysis indicated automatic thoughts(β=0.623,P<0.001)and self-compassion(β=-0.301,P<0.001)significantly predicted mental pain.Mediation analysis confirmed automatic thoughts partially mediated the relationship between self-compassion and mental pain(ab=-0.269,95%CI:-0.363 to-0.212).CONCLUSION Self-compassion is inversely related to mental pain in depression,with automatic thoughts playing a mediating role.These findings suggest potential therapeutic targets for alleviating mental pain in depressed patients.
基金supported by National Key Research and Development Program of China(2018YFC1311203).
文摘Background We aimed to investigate the relationships between metabolic syndrome(MetS)and its severity score(Metsss)with asymptomatic intracranial arterial stenosis(aICAS)while also assessing the additional effect of high-sensitivity C reactive protein(hsCRP).Methods This cross-sectional study included 2390 individuals who underwent health examinations at our centre from June 2019 to August 2023.Participants received physical examinations,laboratory tests and magnetic resonance angiography evaluations.MetS was defined by the modified acknowledged criteria and quantified by Metsss.Logistic regression,interaction analysis and mediation analysis were employed.Results Among the 2390 participants,135(5.65%)had aICAS,and 726(30.40%)had MetS.After adjusting for confounders,MetS was significantly associated with aICAS(OR:1.68,95%CI:1.16 to 2.43,p=0.006).The prevalence of aICAS increased significantly from 3.6%to 8.6%as the number of MetS components increased.Higher quartiles of Metsss also significantly increased aICAS risk(P for trend<0.001).After multivariable adjustment,MetS(p=0.001)and elevated Metsss(p<0.001)were only associated with posterior circulation aICAS(vs anterior).Furthermore,participants with both MetS and elevated hsCRP levels had a greater risk for aICAS(OR:2.32,95%CI:1.36 to 3.96,p=0.002).hsCRP mediated the association between MetS and alCAS in participants≤65 years old.Conclusions MetS and Metsss were independently associated with the risk of aICAS.The mediating effect of hsCRP on the relationship between MetS and aICAS appears to be age-dependent.These findings offer valuable insights into clinical decision making of aICAS and further improve the primary stroke prevention.
基金supported by the National Natural Science Foundation of China(Nos.82273603,82003427,U2004202)。
文摘Hexavalent chromium and its compounds are prevalent pollutants,especially in the work environment,pose a significant risk for multisystem toxicity and cancers.While it is known that chromium accumulation in the liver can cause damage,the dose-response relationship between blood chromium(Cr)and liver injury,as well as the possible potential toxic mechanisms involved,remains poorly understood.To address this,we conducted a follow-up study of 590 visits from 305 participants to investigate the associations of blood Cr with biomarkers for liver injury,including serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),and direct bilirubin(DBIL),and to evaluate the mediating effects of systemic inflammation.Platelet(PLT)and the platelet-to-lymphocyte ratio(PLR)were utilized as biomarkers of systemic inflammation.In the linear mixed-effects analyses,each 1-unit increase in blood Cr level was associated with estimated effect percentage increases of 0.82%(0.11%,1.53%)in TBIL,1.67%(0.06%,3.28%)in DBIL,0.73%(0.04%,1.43%)in ALT and 2.08%(0.29%,3.87%)in AST,respectively.Furthermore,PLT mediated 10.04%,11.35%,and 10.77%increases in TBIL,DBIL,and ALT levels induced by chromate,respectively.In addition,PLR mediated 8.26%and 15.58%of the association between blood Cr and TBIL or ALT.These findings shed light on the mechanisms underlying blood Cr-induced liver injury,which is partly due to worsening systemic inflammation.
基金Supported by Hubei Province Key Research and Development Program Project,Hubei Provincial Department of Science and Technology(No.2022BCA044)Key Scientific Research Projects of Health Commission of Hubei Province in 2023-2024,Health Commission of Hubei Province(No.WJ2023Z006).
文摘AIM:To study the causal relationship between obesityrelated anthropometric traits and myopia and the mediating role of educational attainment(EA).METHODS:Univariable Mendelian randomization(UVMR)was performed to evaluate the causal association between body mass index(BMI),height,waist-hip ratio(WHR,adjusted for BMI),and mean spherical equivalent(MSE).BMI was divided into fat and fat-free mass and included in multivariable Mendelian randomization(MVMR)to explore the roles of different BMI components in the causal relationship between BMI and MSE.A mediation analysis based on two-step Mendelian randomization(MR)was carried out.Specifically,UVMR was conducted to estimate the causal effect of BMI on EA.The direct effect of EA on MSE was estimated from MVMR.The mediation effect of EA in the BMI-EA-MSE model was calculated by the product of coefficients method.Expression quantitative trait loci(eQTL)-MR,reverse MR,and Linkage Disequilibrium Score Regression(LDSC)were performed to assess the robustness.RESULTS:Genetically predicted higher BMI had a positive total effect on MSE(βIVW=0.26 D,95%CI=0.14 to 0.37 D,P<0.001),whereas there was no significant association between height,WHR,and MSE.Fat mass was found to play a significant role in the effect of body mass on MSE(βIVW=0.50 D,95%CI=0.21 to 0.78 D,P=0.001),but there was no significant association between fat-free mass and MSE.The causal effect of BMI on EA was-0.14(95%CI=-0.16 to-0.11,P<0.001),and the direct effect of EA on MSE was-0.63 D(95%CI=-0.81 to-0.44 D,P<0.001).The mediating effect of EA in the BMI-EA-MSE model was 0.09 D(95%CI=0.06 to 0.12 D),with a mediation proportion of 33%(95%CI=22.1%to 44.6%).No reverse causal associations were detected except for BMI on EA.The results of eQTL-MR and LDSC were consistent with each MR analysis.CONCLUSION:Genetically predicted higher BMI decreases the degree of myopia with a 33%mediation proportion by EA,and fat mass provides a dominant protective role in body mass-myopia.As a supplement to previous observational studies,it provides strong evidence for the relationship between anthropometric traits and refractive errors and offers a theoretical basis for future measures to prevent and control myopia.
文摘BACKGROUND Education,cognition,and intelligence are associated with cholelithiasis occurrence,yet which one has a prominent effect on cholelithiasis and which cardiometabolic risk factors mediate the causal relationship remain unelucidated.AIM To explore the causal associations between education,cognition,and intelligence and cholelithiasis,and the cardiometabolic risk factors that mediate the associations.METHODS Applying genome-wide association study summary statistics of primarily European individuals,we utilized two-sample multivariable Mendelian randomization to estimate the independent effects of education,intelligence,and cognition on cholelithiasis and cholecystitis(FinnGen study,37041 and 11632 patients,respectively;n=486484 participants)and performed two-step Mendelian randomization to evaluate 21 potential mediators and their mediating effects on the relationships between each exposure and cholelithiasis.RESULTS Inverse variance weighted Mendelian randomization results from the FinnGen consortium showed that genetically higher education,cognition,or intelligence were not independently associated with cholelithiasis and cholecystitis;when adjusted for cholelithiasis,higher education still presented an inverse effect on cholecystitis[odds ratio:0.292(95%CI:0.171-0.501)],which could not be induced by cognition or intelligence.Five out of 21 cardiometabolic risk factors were perceived as mediators of the association between education and cholelithiasis,including body mass index(20.84%),body fat percentage(40.3%),waist circumference(44.4%),waist-to-hip ratio(32.9%),and time spent watching television(41.6%),while time spent watching television was also a mediator from cognition(20.4%)and intelligence to cholelithiasis(28.4%).All results were robust to sensitivity analyses.CONCLUSION Education,cognition,and intelligence all play crucial roles in the development of cholelithiasis,and several cardiometabolic mediators have been identified for prevention of cholelithiasis due to defects in each exposure.
基金Funding was provided by Universiti Malaysia Pahang(Grant No.RDU1903110).
文摘This study utilizes mediation analysis and bootstrapping to analyze the mediating effect of capital structure on the association between managerial ability and firm performance.The dataset consists of 6384 firm-year observations from the Taiwan Residents electronics industry during 2005–2018.Our results indicate that(1)low(high)levels of debt are likely observed in firms with CEOs with high(low)ability,(2)managerial ability positively affects firm performance,and(3)capital structure mediates the positive relationship between managerial ability and firm performance.Overall,the findings may have limited generalizability due to the specific sample characteristics and provide convincing support for the importance of capital structure as a mediator in the managerial ability-firm performance nexus.Specifically,this study highlights the need for examining the effect of managerial ability on firm performance through a mediator.
基金This work was supported by the National Natural Science Foundation of China(12171451,72091212).
文摘Mendelian randomization(MR)is widely used in causal mediation analysis to control unmeasured confounding effects,which is valid under some strong assumptions.It is thus of great interest to assess the impact of violations of these MR assumptions through sensitivity analysis.Sensitivity analyses have been conducted for simple MR-based causal average effect analyses,but they are not available for MR-based mediation analysis studies,and we aim to fill this gap in this paper.We propose to use two sensitivity parameters to quantify the effect due to the deviation of the IV assumptions.With these two sensitivity parameters,we derive consistent indirect causal effect estimators and establish their asymptotic propersties.Our theoretical results can be used in MR-based mediation analysis to study the impact of violations of MR as-sumptions.The finite sample performance of the proposed method is illustrated through simulation studies,sensitivity ana-lysis,and application to a real genome-wide association study.
基金Universiti Malaysia Pahang for its financial support to this research(University Research Grant Scheme RDU223303).
文摘This study examines how controlling shareholders influence firm performance through the mediating role of firm efficiency in transforming inputs into outputs.To achieve this objective,it conducts a mediation analysis with 5,000 bootstraps on a dataset of 2,849 firm-year observations of publicly listed firms in Malaysia from 2009 to 2019.The findings reveal a positive relationship between controlling shareholdings and firm performance,with both total and indirect effects having this positive relationship.Moreover,while controlling shareholdings improve firm performance,firm efficiency partially mediates this relationship.Thus,improved firm efficiency plays a critical role in understanding the relationship between governance by controlling shareholders and enhanced firm performance.In summary,this study contributes to the existing literature by expanding our understanding of the complex relationship between controlling shareholdings,firm efficiency,and firm performance.In addition,the findings shed light on the importance of indirect channels in shaping organizational outcomes.As such,this study provides a valuable direction for future research in this area.
基金supported by the Natural Science Foundation of Hunan Province,China(2024JJ7627).
文摘Objective:Gut microbiota(GM)and blood metabolites are associated with the development of urticaria,yet their specific causal relationships in East Asian populations remain unclear.This study aims to elucidate the causal and mediating relationships among GM,blood metabolites,and urticaria in East Asians using Mendelian randomization(MR)analysis.Methods:Summary-level statistics for 500 GM taxa,112 blood metabolites,and urticaria were obtained from publicly available Genome-Wide Association Studies(GWAS)datasets.Bidirectional MR analyses were performed to examine causal associations among the GM,blood metabolites,and urticaria.The inverse variance weighted(IVW)method served as the primary analytical approach,supplemented by MR-Egger,weighted median,simple mode,and weighted mode methods.Sensitivity analyses included heterogeneity tests,horizontal pleiotropy assessments,and leave-one-out analyses.Mediation analysis was conducted to evaluate the potential mediating effects of blood metabolites on the causal pathways between GM and urticaria.Results:MR analyses identified 12 GM taxa exhibiting significant causal effects on urticaria susceptibility.Nine taxa,such as MF0017_galactose_degradation(OR=1.461,95%CI 1.098 to 1.944,P=0.009),were associated with increased urticaria risk.Three taxa,such as MF0001_arabinoxylan_degradation(OR=0.846,95%CI 0.737 to 0.973,P=0.019),showed protective effects with increased abundance.Additionally,6 blood metabolites demonstrated causal associations with urticaria.Notably,the risk of developing urticaria increases with rising fasting plasma glucose(FPG)levels(OR=1.971,95%CI 1.089 to 3.567,P=0.025).Mediation analysis further demonstrated that FPG partially mediated the protective effect of MF0001_arabinoxylan_degradation on urticaria,accounting for 11.30%of the total effect.Conclusion:This study has delineated specific GM taxa and blood metabolites that hold causal relevance to urticaria in East Asian populations.Notably,arabinogalactan degradation potentially mitigates urticaria risk via reducing FPG concentrations,offering genetic evidence to support therapeutic strategies targeting GM modulation and glucose regulation.
基金Supported by National Natural Science Foundation Youth Project,No.72204123China Social Welfare Foundation-Nurse Care Fund,No.HLCXKT-20230130.
文摘BACKGROUND Cervical cancer survivors of childbearing age often face heightened reproductive anxiety due to the direct impact of the disease and its treatments on fertility.This anxiety may exacerbate psychological burdens,including depressive symptoms and fear of recurrence,significantly impacting quality of life.AIM To examine whether reproductive concerns partially mediate the relationship between depressive symptoms and fear of recurrence in cervical cancer patients of childbearing age.METHODS Utilizing a cross-sectional design with convenience sampling,208 eligible cervical cancer patients(aged 18-45 years,stable condition,and aware of diagnosis)from three tertiary hospitals completed validated questionnaires:The Reproductive Concerns After Cancer Scale,Patient Health Questionnaire-9,and Fear of Cancer Recurrence Questionnaire.Structural equation modeling was used to assess the mediating role of reproductive concerns in the relationship between depression and fear of recurrence.RESULTS Reproductive concerns demonstrated significant positive correlations with depression(r=0.477,P<0.001)and fear of recurrence(r=0.426,P<0.001).Structural equation modeling analysis revealed that reproductive concerns acted as a significant partial mediator between depression and fear of recurrence.The indirect effect via reproductive concerns was significant(β_indirect=0.152,P<0.001),accounting for 28.1% of the total effect of depression on fear of recurrence.CONCLUSION Identified path reveals fertility anxiety links depression to recurrence fear.Targeted psych interventions for repro concerns may ease both in childbearing cervical cancer survivors.
基金Supported by the New Professor Research Program of KOREATECH,No.202501930001.
文摘This letter critically examines a recent study by Zhang et al investigating the mediating role of overweight in the association between depression and new-onset diabetes among middle-aged and older adults.The study provides com-pelling evidence that overweight mediates approximately 61%of this relationship,suggesting that depression may contribute to diabetes by influencing behaviors that lead to weight gain.This aligns with the understanding that depression can impact appetite regulation and physical activity.While the study employs a longitudinal design and robust statistical methods,limitations such as reliance on self-reported data and body mass index measurements warrant consideration.This analysis emphasizes the need for integrated interventions that address both mental and metabolic health for effective diabetes prevention.Future research should further explore the interplay of lifestyle factors,biological pathways,and social determinants in the development of this complex relationship.Ultimately,an integrated approach targeting both behavioral and biological components is crucial for the prevention and management of new-onset diabetes.
基金supported by the Science&Technology Program of Guizhou Province(Nos.QKHPTRC-GCC[2022]039-1,QKHPTRC-CXTD[2022]014,and QKHHBZ[2020]3002)the Scientific Research Programof Guizhou Provincial Department of Education(No.QJJ[2023]019).
文摘Anemia is still prevalent among low and middle-income countries,posing serious family and social burdens.However,scarce studies provided evidence for real-world exposure to polycyclic aromatic hydrocarbons(PAHs)and anemia among pregnant women,as well as involved biological mechanisms.So,we conducted this study including 1717 late pregnant women fromZunyi Birth Cohort and collected urine samples for PAHs metabolites detection.Logistic regression and restricted cubic spline regression were used to examine exposuredisease risks and dose-response relationships.We conducted Bayesian kernel machine regression,weighted quantile sum regression,and quantile g-computation regression to fit the joint impacts of multiple PAHs in the real-world scenario on hypocalcemia and anemia.Results showed single exposure to 2-OHNap,2-OHFlu,9-OHFlu,1-OHPhe,2-OHPhe,3-OHPhe,and 1-OHPyr(all P-trend<0.05)increased the risks of hypocalcemia and anemia.Moreover,PAHs mixture was significantly related to higher risks of hypocalcemia and anemia,with 3-OHPhe and 1-OHPyr identified as their major drivers,respectively.Importantly,hypocalcemia served as a significant biological mechanism responsible for PAHs and anemia.Our findings suggest that individual and joint exposure to PAHs during late pregnancy elevate the anemia risk,and calcium supplementation might be a low-cost intervention target for reducing the PAHs-related impairment on anemia for pregnant women.
基金supported by grants from the National Natural Science Foundation of China(82192902 and 82325043)the National Key R&D Program of China(2023YFC3606300)supported by grants from the National Natural Science Foundation of China(82273623 and 82073554).
文摘Objective To identify whether metabolic status mediates the associations between frailty and mortality and incident cardiovascular disease(CVD),and to assess of interactive or joint relationships between frailty and metabolic status on these outcomes.Methods In this prospective cohort study of 456,445 UK Biobank participants,frailty was assessed using five phenotype criteria.Metabolic status was scored(0–4)based on central obesity,hypertension,hyperglycemia,and dyslipidemia.Multivariable-adjusted Cox regression models were used to assess the associations between frailty and mortality and incident CVD.Results During a median follow-up of 13.8 years for mortality and 13.6 years for CVD,30,907 deaths(7,467 CVD-related)and 37,115 incident CVD cases occurred.Frailty was associated with higher risks of all-cause mortality(hazard ratio[HR],2.41;95%confidence interval[CI],2.31–2.51),CVD mortality(HR,2.64;95%CI,2.43–2.87),and incident CVD(HR,1.83;95%CI,1.75–1.91),compared with non-frail individuals.Metabolic status mediated 8.7%,16.1%,and 16.4%of these associations,respectively.Frailty and metabolic status interacted multiplicatively for all-cause mortality(P-value for interaction<0.001)and additively for CVD mortality[relative excess risk due to interaction(RERI),1.78;95%CI,0.88–2.68]and incident CVD(RERI,0.60;95%CI,0.33–0.86).Joint exposure to frailty and three to four metabolic disorders conferred 3.34-,6.32-,and 3.30-fold risks of all-cause mortality,CVD mortality,and incident CVD,respectively,compared with metabolically healthy non-frail individuals.Conclusion This study highlights the need for integrated management strategies targeting both frailty and metabolic conditions to mitigate cardiovascular and mortality risks.
文摘The associations of volatile organic compounds(VOCs)exposure with short sleep duration(SSD)have rarely been studied.We aimed to evaluate the correlation between VOC exposure and SSD risk,while also exploring the potential mediating influence of depressive symptoms.Blood concentrations of seven VOCs,namely benzene,toluene,ethylbenzene,m-/p-xylene,o-xylene,styrene(collectively known as BTEXS),and 1,4-dichlorobenzene,were analyzed in 2905 U.S.adults.Weighted logistic regression,quantile-based g-computation(QGC),and weighted quantile sum(WQS)regression were employed to investigate associations between selected VOCs and SSD risk.Mediation analyses were conducted to explore the potential mediating effects of depressive symptoms on these relationships.Increased blood levels of BTEXS were positively correlated with SSD risk,with odds ratios(OR)ranging from 1.130 to 1.212(all P<0.05).A nonlinear association between toluene concentration and SSD risk was observed(P for nonlinearity=0.028).Both QGC and WQS analyses indicated a positive association between co-exposure to VOCs and SSD,with styrene showing the highest positive weights(QGC:OR=1.313,95%confidence interval(CI):1.038–1.660;WQS:OR=1.386,95%CI:1.111–1.731).Furthermore,BTEXS exposure was positively linked to depressive symptoms,which in turn were significantly associated with SSD risk.Mediation analyses revealed that depressive symptoms partially mediated the relationships between individual and mixed VOCs and SSD risk,with mediation proportions ranging from 15.87%to 20.54%(all P<0.05).These findings indicated that exposure to VOCs increased SSD risk,with depressive symptoms playing a partial mediating role.
文摘Objective:Chronic noncommunicable conditions are a major driver of poor health in low-and middle-income countries,yet the mental health pathways through which these illnesses shape perceived health remain underexamined.This study investigates whether recent mental well-being—measured using the World Health Organization Five-Item Well-Being Index(WHO-5)—mediates the association between chronic illness and self-rated health(SRH)among Egyptian adults aged 32–65.Methods:This study uses nationally representative data from the 2023 Egypt Labor Market Panel Survey(n=23,044)and estimates survey-weighted Ordinary Least Squares models predicting SRH(1=very good/excellent to 5=very bad).The key independent variable is chronic illness status.Mediation analysis is conducted using the Sobel–Goodman method with 1000 bootstrap replicates.All models adjust for sociodemographic covariates including age,sex,education,marital status,and regional residence.Results:Chronic illness is associated with significantly worse SRH(β=0.59,standard error[SE]=0.02,P<0.001).When mental well-being is added to the model,the chronic illness coefficient declines to 0.50(SE=0.02,P<0.001),and WHO-5 is independently associated with better SRH(β=-0.22,SE=0.01,P<0.001).The indirect effect via WHO-5 is 0.08(SE=0.01,P<0.001),indicating that 14.2%of the total association is mediated through recent psychological well-being.Conclusion:Although most of the self-rated health disadvantage linked to chronic illness flows through somatic and functional channels,mental well-being accounts for a meaningful share.Incorporating WHO-5 screening and stepped referral into chronic care could improve subjective health outcomes in Egypt.Mental health integration should be viewed as a critical component of equitable noncommunicable disease strategies.
文摘Background Coronary artery calcification(CAC),a hallmark of atherosclerosis,paradoxically associates with reduced cardiovascular risk under statin therapy despite accelerated calcification progression,prompting this study to explore CAC metrics as potential mediators between statin use and major adverse cardiovascular events(MACE).Methods Clinical data of 246 hospitalized patients who underwent coronary computed tomography angiography(CCTA)at Guangdong Provincial People's Hospital from January 2023 to June 2023 were retrospectively analyzed.Linear regression was used to evaluate the relationship between statin use and CAC parameters.Multivariable Poisson regression models were applied to explore the associations of statin use and CAC parameters with MACE risk.A mediation analysis was performed to assess the role of CAC parameters in the statin-MACE relationship.Results Statin use was independently associated with increased calcification score(β=0.648,P<0.001),CAC volume(β=0.623,P<0.001),and calcified plaque proportion(β=0.606,P=0.002).Multivariable Poisson regression indicated that statin use significantly reduced MACE risk[incidence rate ratio(IRR):0.33,P=0.018],whereas calcification score(IRR:2.63,P=0.026)and CACvolume(IRR:2.66,P=0.044)were associated with elevated MACE risk;Calcified plaque proportion showed no significant association.Mediation analysis revealed that calcification score(β=0.035,P=0.021)and CAC volume(β=0.023,P=0.018)exerted masking effects,while calcified plaque proportion had no mediating role.Conclusions Calcification score and CACvolume demonstrated limited masking effects in the association between statin use and MACE.
基金Ministry of Education Humanities and Social Sciences Research General Project“Study on the Responsibility Sharing Accounting and Accountability Mechanism for Coordinated Air Pollution Control in the Yellow River Basin”Project[Grant No.24YJC630260].
文摘To investigate how spatial heterogeneity affects the so-called“resource curse”in China,we combine a careful selection of indicators with the concept of resource industry spatial agglomeration(RISA)as a proxy for resource abundance and dependency.To address RISA heterogeneity among regions,those lacking a spatial concentration in non-resource industries are excluded from the analysis.We then develop an econometric model of regional economic growth(REG)using RISA.To further investigate the impact mechanisms of RISA and other factors influencing REG,we use the feasible generalized least squares(FGLS)method and the system generalized method of moments(SGMM).Conducting a stepwise regression analysis,we systematically examine the effect of the resource curse at the regional level from a RISA perspective.Our key findings are as follows:①Fifteen provinces in China exhibit RISA,and their level of economic development is significantly lower than that of provinces without a spatial agglomeration of resource industries.②RISA and REG exhibit a“U-shaped”relationship,characterized initially by suppression followed by promotion.③In terms of transmission mechanisms,investments in material and human capital,the degree of openness to foreign trade,and residents’savings rate all suppress RISA,while investments in technological innovation,development of the private economy and the manufacturing industry,and government intervention can promote spatial agglomeration of resource industries.
文摘Objective To study the importance of digital economy to promote the innovation development of enterprises under the background of the era of information technology reform.Methods The maximum entropy method was used to measure the comprehensive level of digital economy development at provincial level.Besides,the impact of digital economy on the innovation performance of pharmaceutical industry was investigated empirically by using A-share pharmaceutical companies listed in China from 2013 to 2020 as a research sample,and the mediating mechanism of R&D investment and financing constraints on the impact was examined.Results and Conclusion It is found that digital economy is significantly and positively related to the innovation performance of enterprises.The mechanism test shows that digital economy improves innovation performance through the expansion effect of R&D investment and alleviating financing constraints.In the context that digital economy has become a new driving force for enterprise innovation,the combination of digital economy and real economy should be actively promoted,R&D investment in pharmaceutical enterprises should be increased,and financing channels should be broadened.
