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
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
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
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
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
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 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
Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examin...Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications.We further tested the role of this mediation effect using mean arterial pressure,a hemodynamic indicator.Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis.We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications.We conducted mediation analysis using the mediation package in R(version 3.1.2),based on 5,000 bootstrapped samples,adjusting for covariates.Results Among the 300 patients in the study,40%(120/300)developed postoperative complications within 30 days.GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders(odds ratio:0.460,95%CI:0.278,0.761;P=0.003).The total effect of GDFT on postoperative complications was-0.18(95%CI:-0.28,-0.07;P<0.01).The average causal mediation effect was-0.08(95%CI:-0.15,-0.04;P<0.01).The average direct effect was-0.09(95%CI:-0.20,0.03;P=0.17).The proportion mediated was 49.9%(95%CI:18.3%,140.0%).Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications.Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.展开更多
The current study used multivariable logistic regression analysis to investigate associations between the intake frequencies of 13 food groups(or four diet groups)and infectious diseases.The analysis included 487849 p...The current study used multivariable logistic regression analysis to investigate associations between the intake frequencies of 13 food groups(or four diet groups)and infectious diseases.The analysis included 487849 participants from the UK Biobank,with 75209 participants diagnosed with infectious diseases.Participants reporting the highest intake frequency of processed meat(odds ratio[OR]=1.0964,95%confidence interval[CI]:1.0622–1.1318)and red meat(OR=1.0895,95%CI:1.0563–1.1239)had a higher risk of infectious diseases,compared with those with the lowest intake frequency.Consuming fish 2.0–2.9 times(OR=0.8221,95%CI:0.7955–0.8496),cheese≥5.0 times(OR=0.8822,95%CI:0.8559–0.9092),fruit 3.0–3.9 servings(OR=0.8867,95%CI:0.8661–0.9078),and vegetables 2.0–2.9 servings(OR=0.9372,95%CI:0.9189–0.9559)per week were associated with a lower risk of infection.Low meat-eaters(OR=0.9404,95%CI:0.9243–0.9567),fish-eaters(OR=0.8391,95%CI:0.7887–0.8919),and vegetarians(OR=0.9154,95%CI:0.8561–0.9778)had a lower risk of infectious diseases,compared with regular meat-eaters.The mediation analysis revealed that glycosylated hemoglobin,white blood cell count,and body mass index served as the mediators in the associations between diet and infectious diseases.The current study indicates that the intake frequency of food groups is a risk factor for infectious diseases,and fish-eaters have a lower risk of infection.展开更多
BACKGROUND Interoception dysfunction has an important impact on the onset and development of major depressive disorder(MDD).Social support serves as a protective factor against MDD,and sociability also plays a signifi...BACKGROUND Interoception dysfunction has an important impact on the onset and development of major depressive disorder(MDD).Social support serves as a protective factor against MDD,and sociability also plays a significant role in this condition.These interconnected constructs-social support and sociability-play pivotal roles in MDD.However,no research on the mechanisms underlying the associations be-tween social support and sociability,particularly the potential role of interocep-tion,have been reported.ception,social support,and sociability,respectively.A mediation analysis model for the eight dimensions of intero-ception(noticing,not distracting,not worrying,attention regulation,emotional awareness,self-regulation,body listening,and trust),social support,and sociability were established to evaluate the mediating effects.RESULTS A partial correlation analysis of eight dimensions of the MAIA-2,SSRS,and TSBI scores,with demographic data as control variables,revealed pairwise correlations between the SSRS score and both the MAIA-2 score and TSBI score.In the major depression(MD)group,the SSRS score had a positive direct effect on the TSBI score,while the scores for body listening,emotional awareness,self-regulation,and trust in the MAIA-2C had indirect effects on the TSBI score.In the HC group,the SSRS score had a positive direct effect on the TSBI score,and the scores for attention regulation,emotional awareness,self-regulation,and trust in the MAIA-2C had indirect effects on the TSBI score.The proportion of mediators in the MD group was lower than that in the HC group.CONCLUSION Interoceptive awareness is a mediating factor in the association between social support and sociability in both HCs and depressed patients.Training in interoceptive awareness might not only help improve emotional regulation in depressed patients but also enhance their social skills and support networks.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 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
Urolithiasis,a disease characterized by the formation of urinary stones,is influenced by immune system dysregulation and metabolic factors.This study investigated the interplay between specific immune cell characteris...Urolithiasis,a disease characterized by the formation of urinary stones,is influenced by immune system dysregulation and metabolic factors.This study investigated the interplay between specific immune cell characteristics and blood metabolites in urolithiasis based on Mendelian randomization.We further explored the potential mediating effects of genetically predicted blood metabolites based on mediation analysis.We employed a two-sample Mendelian randomization analysis to examine the association between immune cell properties,blood metabolites,and urolithiasis risk.Genetic instruments for immune cell characteristics and blood metabolites were used to assess causal relationships and mediating pathways.Our results indicate that 10 immune cell characteristics had a unidirectional causal association with urolithiasis risk.We also detected 13 blood metabolites associated with urolithiasis.We identified 4 pathways through which genetically predicted blood metabolites partly mediated the association between specific immune cell characteristics and urolithiasis risk.This suggests potential mechanistic links where altered blood metabolites may play a role in developing urolithiasis through immune system modulation.This Mendelian randomization study highlights the complex relationship between immune responses,blood metabolites,and urolithiasis.The findings underscore the importance of considering both immune cell features and metabolic factors in understanding the pathogenesis of urolithiasis,offering insights into novel therapeutic targets and diagnostic strategies for this disorder.展开更多
Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change,it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies...Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change,it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies.Water quality may be the most important mediator,while relevant empirical evidence is limited.This study aimed to examine the role of water quality in the process of infectious diarrhea caused by extreme precipitation.Weekly infectious diarrhea cases,meteorological factors and water quality data in Yangtze River Basin in China between October 29,2007 to February 19,2017 were obtained.Two-stage statistical models were used to estimate city-specific extreme precipitation,water quality and infectious diarrhea relationships that were pooled to derive regional estimates.A causal mediation analysis was used to assess the mediation effect of water quality.In Yangtze River Basin,extreme precipitation events had a significant impact on infectious diarrhea(Incidence Rate Ratios[IRR]:1.027,95%Confidence Interval[CI]:1.013~1.041).After extreme precipitation events,the dissolved oxygen(DO)in surface water decreased(-0.123 mg/L,95%CI:-0.159 mg/L~-0.086 mg/L),while the un-ionized ammonia(NH(3)-N)increased(0.004 mg/L,95%CI:0.001 mg/L~0.006 mg/L).The combined overall effect of DO and NH(3)-N on infectious diarrhea showed that both low and high concentrations were associated with an increased risk of infectious diarrhea.The causal mediation analysis showed that the mediation proportion of the two water quality indexes(DO and NH(3)-N)is 70.54%(P<0.001).To reduce the health effects of extreme precipitation,in contrast to current population-oriented health strategies,those that take into account more direct and easy-to-intervene water quality indicators should be encouraged by future policies.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
Background This study aimed to investigate the relationship between overall obesity,central obesity and brain volumes,as well as to determine the extent to which cardiometabolic and inflammatory measures act as mediat...Background This study aimed to investigate the relationship between overall obesity,central obesity and brain volumes,as well as to determine the extent to which cardiometabolic and inflammatory measures act as mediators in the association between body mass index(BMI),waist-hip ratio(WHR)and brain volumes.Methods In the context of counterfactual framework,mediation analysis was used to explore the potential mediation in which cardiometabolic and inflammatory measures may mediate the relationship between BMI,WHR,and brain volumes.Results Among 2413 community-dwelling participants,those with high BMI or WHR levels experienced an approximately brain ageing of 4 years.Especially,individuals with high WHR or BMI under the age of 65 exhibited white matter hyperintensity volume(WMHV)differences equivalent to around 5 years of ageing.Conversely,in the high-level WHR population over the age of 65,premature brain ageing in gray matter volume(GMV)exceeded 4.5 years.For GMV,more than 45%of the observed effect of WHR was mediated by glycaemic metabolism indicators.This proportion increases to 78.70%when blood pressure,triglyceride,leucocyte count,and neutrophil count are jointly considered with glycaemic metabolism indicators.Regarding WHR and BMI’s association with WMHV,cardiometabolic and inflammatory indicators,along with high-density lipoprotein cholesterol,mediated 35.50%and 20.20%of the respective effects.Conclusions Overall obesity and central obesity were associated with lower GMV and higher WMHV,a process that is partially mediated by the presence of cardiometabolic and inflammatory measures.展开更多
This study explores the intricate relationships among absorptive capacity,innovation,and financial performance in nonfinancial firms.Using data from COMPUSTAT spanning 1966 to 2020,including 25,392 observations,Tobin&...This study explores the intricate relationships among absorptive capacity,innovation,and financial performance in nonfinancial firms.Using data from COMPUSTAT spanning 1966 to 2020,including 25,392 observations,Tobin's Q is used as a measure of financial performance.Absorptive capacity,measured by the ratio of research and development expenses to total revenue,has a significant positive direct impact on both innovation and financial performance.However,innovation,represented by the natural logarithm of total intangible assets,has a negative influence on financial performance and mediates the positive relationship between absorptive capacity and financial performance.This reveals the suppressive role of innovation in the absorptive capacity-financial performance relationship.This challenges the conventional belief that innovation invariably leads to improved financial outcomes,highlighting the nuanced dynamics involved.The study underscores the trade-offs between short-term gains and long-term potential,emphasizing the complexity of organizational success in today's competitive landscape.展开更多
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.
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 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.
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.
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 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.
基金supported by the National High Level Hospital Clinical Research Funding(2022-PUMCHB-119).
文摘Objective Although goal-directed fluid therapy(GDFT)has been proven to be effective in reducing the incidence of postoperative complications,the underlying mechanisms remain unknown.The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications.We further tested the role of this mediation effect using mean arterial pressure,a hemodynamic indicator.Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis.We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications.We conducted mediation analysis using the mediation package in R(version 3.1.2),based on 5,000 bootstrapped samples,adjusting for covariates.Results Among the 300 patients in the study,40%(120/300)developed postoperative complications within 30 days.GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders(odds ratio:0.460,95%CI:0.278,0.761;P=0.003).The total effect of GDFT on postoperative complications was-0.18(95%CI:-0.28,-0.07;P<0.01).The average causal mediation effect was-0.08(95%CI:-0.15,-0.04;P<0.01).The average direct effect was-0.09(95%CI:-0.20,0.03;P=0.17).The proportion mediated was 49.9%(95%CI:18.3%,140.0%).Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications.Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.
基金supported by the National Natural Science Foundation of China(Grant Nos.82173585 and 82273741)the Natural Science Foundation of Jiangsu Higher Education Institutions of China(Grant Nos.21KJB330005 and 22KJB330007)+1 种基金the Nanjing Major Science and Technology Project(Grant No.2021-11005)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘The current study used multivariable logistic regression analysis to investigate associations between the intake frequencies of 13 food groups(or four diet groups)and infectious diseases.The analysis included 487849 participants from the UK Biobank,with 75209 participants diagnosed with infectious diseases.Participants reporting the highest intake frequency of processed meat(odds ratio[OR]=1.0964,95%confidence interval[CI]:1.0622–1.1318)and red meat(OR=1.0895,95%CI:1.0563–1.1239)had a higher risk of infectious diseases,compared with those with the lowest intake frequency.Consuming fish 2.0–2.9 times(OR=0.8221,95%CI:0.7955–0.8496),cheese≥5.0 times(OR=0.8822,95%CI:0.8559–0.9092),fruit 3.0–3.9 servings(OR=0.8867,95%CI:0.8661–0.9078),and vegetables 2.0–2.9 servings(OR=0.9372,95%CI:0.9189–0.9559)per week were associated with a lower risk of infection.Low meat-eaters(OR=0.9404,95%CI:0.9243–0.9567),fish-eaters(OR=0.8391,95%CI:0.7887–0.8919),and vegetarians(OR=0.9154,95%CI:0.8561–0.9778)had a lower risk of infectious diseases,compared with regular meat-eaters.The mediation analysis revealed that glycosylated hemoglobin,white blood cell count,and body mass index served as the mediators in the associations between diet and infectious diseases.The current study indicates that the intake frequency of food groups is a risk factor for infectious diseases,and fish-eaters have a lower risk of infection.
基金Supported by the Wuxi Municipal Health Commission Major Project,No.202107.
文摘BACKGROUND Interoception dysfunction has an important impact on the onset and development of major depressive disorder(MDD).Social support serves as a protective factor against MDD,and sociability also plays a significant role in this condition.These interconnected constructs-social support and sociability-play pivotal roles in MDD.However,no research on the mechanisms underlying the associations be-tween social support and sociability,particularly the potential role of interocep-tion,have been reported.ception,social support,and sociability,respectively.A mediation analysis model for the eight dimensions of intero-ception(noticing,not distracting,not worrying,attention regulation,emotional awareness,self-regulation,body listening,and trust),social support,and sociability were established to evaluate the mediating effects.RESULTS A partial correlation analysis of eight dimensions of the MAIA-2,SSRS,and TSBI scores,with demographic data as control variables,revealed pairwise correlations between the SSRS score and both the MAIA-2 score and TSBI score.In the major depression(MD)group,the SSRS score had a positive direct effect on the TSBI score,while the scores for body listening,emotional awareness,self-regulation,and trust in the MAIA-2C had indirect effects on the TSBI score.In the HC group,the SSRS score had a positive direct effect on the TSBI score,and the scores for attention regulation,emotional awareness,self-regulation,and trust in the MAIA-2C had indirect effects on the TSBI score.The proportion of mediators in the MD group was lower than that in the HC group.CONCLUSION Interoceptive awareness is a mediating factor in the association between social support and sociability in both HCs and depressed patients.Training in interoceptive awareness might not only help improve emotional regulation in depressed patients but also enhance their social skills and support networks.
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support from various sources including the Innovation and Development Joint Fund of Chongqing Natural Science Foundation of China(No.CST-B2023NSCQ-LZX0099)Chongqing Science and Health Joint Medical High-end Talent Project(China)(No.2022GDRC012)+3 种基金Science and Technology Research Program of Chongqing Municipal Education Commission of China(No.KJZD-K202100402)CQMU Program for Youth Innovation in Future Medicine(Chongqing,China)(No.W0073)National Natural Science Foundation of China(82401866)Special Grants for Postdoctoral Research Projects in Chongqing in 2023(2023CQBSHTB3134).
文摘Urolithiasis,a disease characterized by the formation of urinary stones,is influenced by immune system dysregulation and metabolic factors.This study investigated the interplay between specific immune cell characteristics and blood metabolites in urolithiasis based on Mendelian randomization.We further explored the potential mediating effects of genetically predicted blood metabolites based on mediation analysis.We employed a two-sample Mendelian randomization analysis to examine the association between immune cell properties,blood metabolites,and urolithiasis risk.Genetic instruments for immune cell characteristics and blood metabolites were used to assess causal relationships and mediating pathways.Our results indicate that 10 immune cell characteristics had a unidirectional causal association with urolithiasis risk.We also detected 13 blood metabolites associated with urolithiasis.We identified 4 pathways through which genetically predicted blood metabolites partly mediated the association between specific immune cell characteristics and urolithiasis risk.This suggests potential mechanistic links where altered blood metabolites may play a role in developing urolithiasis through immune system modulation.This Mendelian randomization study highlights the complex relationship between immune responses,blood metabolites,and urolithiasis.The findings underscore the importance of considering both immune cell features and metabolic factors in understanding the pathogenesis of urolithiasis,offering insights into novel therapeutic targets and diagnostic strategies for this disorder.
基金supported by the National Key R&D Program of China(2018YFA0606200)Sanming Project of Medicine in Shenzhen,China(SZSM202111001).
文摘Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change,it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies.Water quality may be the most important mediator,while relevant empirical evidence is limited.This study aimed to examine the role of water quality in the process of infectious diarrhea caused by extreme precipitation.Weekly infectious diarrhea cases,meteorological factors and water quality data in Yangtze River Basin in China between October 29,2007 to February 19,2017 were obtained.Two-stage statistical models were used to estimate city-specific extreme precipitation,water quality and infectious diarrhea relationships that were pooled to derive regional estimates.A causal mediation analysis was used to assess the mediation effect of water quality.In Yangtze River Basin,extreme precipitation events had a significant impact on infectious diarrhea(Incidence Rate Ratios[IRR]:1.027,95%Confidence Interval[CI]:1.013~1.041).After extreme precipitation events,the dissolved oxygen(DO)in surface water decreased(-0.123 mg/L,95%CI:-0.159 mg/L~-0.086 mg/L),while the un-ionized ammonia(NH(3)-N)increased(0.004 mg/L,95%CI:0.001 mg/L~0.006 mg/L).The combined overall effect of DO and NH(3)-N on infectious diarrhea showed that both low and high concentrations were associated with an increased risk of infectious diarrhea.The causal mediation analysis showed that the mediation proportion of the two water quality indexes(DO and NH(3)-N)is 70.54%(P<0.001).To reduce the health effects of extreme precipitation,in contrast to current population-oriented health strategies,those that take into account more direct and easy-to-intervene water quality indicators should be encouraged by future policies.
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supported by National Key R&D Programme of China(No.2022YFC3602500,2022YFC3602505)National Natural Science Foundation of China(81971091)+3 种基金Outstanding Young Talents Project of Capital Medical University(A2105)Capital’s Funds for Health Improvement and Research(2020-1-2041)Key Science&Technologies R&D Programme of Lishui City(2019ZDYF18)Zhejiang Provincial Programme for the Cultivation of High-level Innovative Health talents and AstraZeneca Investment(China)Co.,Ltd.
文摘Background This study aimed to investigate the relationship between overall obesity,central obesity and brain volumes,as well as to determine the extent to which cardiometabolic and inflammatory measures act as mediators in the association between body mass index(BMI),waist-hip ratio(WHR)and brain volumes.Methods In the context of counterfactual framework,mediation analysis was used to explore the potential mediation in which cardiometabolic and inflammatory measures may mediate the relationship between BMI,WHR,and brain volumes.Results Among 2413 community-dwelling participants,those with high BMI or WHR levels experienced an approximately brain ageing of 4 years.Especially,individuals with high WHR or BMI under the age of 65 exhibited white matter hyperintensity volume(WMHV)differences equivalent to around 5 years of ageing.Conversely,in the high-level WHR population over the age of 65,premature brain ageing in gray matter volume(GMV)exceeded 4.5 years.For GMV,more than 45%of the observed effect of WHR was mediated by glycaemic metabolism indicators.This proportion increases to 78.70%when blood pressure,triglyceride,leucocyte count,and neutrophil count are jointly considered with glycaemic metabolism indicators.Regarding WHR and BMI’s association with WMHV,cardiometabolic and inflammatory indicators,along with high-density lipoprotein cholesterol,mediated 35.50%and 20.20%of the respective effects.Conclusions Overall obesity and central obesity were associated with lower GMV and higher WMHV,a process that is partially mediated by the presence of cardiometabolic and inflammatory measures.
文摘This study explores the intricate relationships among absorptive capacity,innovation,and financial performance in nonfinancial firms.Using data from COMPUSTAT spanning 1966 to 2020,including 25,392 observations,Tobin's Q is used as a measure of financial performance.Absorptive capacity,measured by the ratio of research and development expenses to total revenue,has a significant positive direct impact on both innovation and financial performance.However,innovation,represented by the natural logarithm of total intangible assets,has a negative influence on financial performance and mediates the positive relationship between absorptive capacity and financial performance.This reveals the suppressive role of innovation in the absorptive capacity-financial performance relationship.This challenges the conventional belief that innovation invariably leads to improved financial outcomes,highlighting the nuanced dynamics involved.The study underscores the trade-offs between short-term gains and long-term potential,emphasizing the complexity of organizational success in today's competitive landscape.
