Association and mediation analyses among multiple metal exposure, mineralocorticoid levels, and serum ion balance in residents of northwest China.

Toxic metals are vital risk factors affecting serum ion balance; however, the effect of their co-exposure on serum ions and the underlying mechanism remain unclear. We assessed the correlations of single metal and mixed metals with serum ion levels, and the mediating effects of mineralocorticoids by investigating toxic metal concentrations in the blood, as well as the levels of representative mineralocorticoids, such as deoxycorticosterone (DOC), and serum ions in 471 participants from the Dongdagou-Xinglong cohort. In the single-exposure model, sodium and chloride levels were positively correlated with arsenic, selenium, cadmium, and lead levels and negatively correlated with zinc levels, whereas potassium and iron levels and the anion gap were positively correlated with zinc levels and negatively correlated with selenium, cadmium and lead levels (all P < 0.05). Similar results were obtained in the mixed exposure models considering all metals, and the major contributions of cadmium, lead, arsenic, and selenium were highlighted. Significant dose-response relationships were detected between levels of serum DOC and toxic metals and serum ions. Mediation analysis showed that serum DOC partially mediated the relationship of metals (especially mixed metals) with serum iron and anion gap by 8.3% and 8.6%, respectively. These findings suggest that single and mixed metal exposure interferes with the homeostasis of serum mineralocorticoids, which is also related to altered serum ion levels. Furthermore, serum DOC may remarkably affect toxic metal-related serum ion disturbances, providing clues for further study of health risks associated with these toxic metals.

Mediating and Moderating Variables in the Relationship Between Emotional Demands and Teachers’ Emotional Exhaustion / [Variables mediadoras y moderadoras de la relación entre exigencias emocionales y agotamiento emocional en docentes]

Teachers tend to suffer high levels of emotional exhaustion, a variable that is associated with poor mental health and lower job performance. The present study analyzed how emotional demands, emotional dissonance, and self-efficacy to cope with stress interact in predicting teachers’ emotional exhaustion. To conduct this longitudinal research, 108 Andalusian teachers (57.3% women; mean age = 45.30, SD = 8.68) completed an online survey at three different time points. Moderated mediation analysis suggested that emotional dissonance mediated the relationship between emotional demands and emotional exhaustion, with self-efficacy acting as a moderator between the two. Teachers who perceived high emotional demands saw their levels of emotional dissonance increase, which in turn led to an increase in emotional exhaustion. In addition, self-efficacy acted as a protective factor against emotional exhaustion, buffering the negative effect of emotional dissonance. Strengthening these protective variables through interventions that increase levels of self-efficacy to cope with stress and reduce levels of emotional dissonance could help prevent teachers’ emotional exhaustion.(AU)

Los docentes tienden a sufrir un nivel elevado de agotamiento emocional, variable que se asocia con una mala salud mental y un bajo desempeño laboral. El estudio analiza cómo interactúan en la prevención del agotamiento emocional de los docentes las exigencias emocionales, la disonancia emocional y la autoeficacia para afrontar el estrés. Para llevar a cabo esta investigación de carácter longitudinal, 108 profesores andaluces (57.3% mujeres, edad media = 45.30, DT = 8.68) cumplimentaron una encuesta online en tres momentos distintos. El análisis de mediación moderada indicaba que la disonancia emocional mediaba la relación existente entre las exigencias emocionales y el agotamiento emocional, actuando como moderadora entre ambos la autoeficacia. Los profesores que percibieron exigencias emocionales elevadas vieron aumentar su grado de disonancia emocional, lo que a su vez aumentó el agotamiento emocional. Además, la autoeficacia actuó como factor protector del agotamiento emocional, amortiguando el efecto negativo de la disonancia emocional. Reforzar estas variables protectoras a través de intervenciones que aumenten el grado de autoeficacia para afrontar el estrés y reduzcan la disonancia emocional podría ayudar a prevenir el agotamiento emocional de los docentes.(AU)

Mental Imagery in the Relationship between Alexithymia and Parental Psychological Control.

This study aims to explore the mediating role of mental imagery in the relationship between alexithymia and parental psychological control among Chinese university students. Conducted between March and April 2023, this descriptive study involved 282 volunteer participants from a university in southern China. Data collection included the Toronto Alexithymia Scale (TAS), the Parental Psychological Control Scale (PPC), and the Vividness of Visual Mental Imagery questionnaire (VVIQ). The results revealed that: (1) based on established cut-off, 81 students were identified as highly alexithymic; (2) the alexithymia group scored higher on both the TAS and PPC and lower on the VVIQ compared to the non-alexithymia and possible-alexithymia groups; and (3) mediating analysis demonstrated a strong and positive correlation between parental psychological control and alexithymia for all participants, with visual mental imagery mediating this relationship. This study underscores the interconnectedness of parental psychological control, visual mental imagery, and alexithymia among college students. The theoretical and clinical implications of these findings are also discussed.

Social participation, subjective well-being, and cognitive function as serial mediators between tooth loss and functional limitations in older Chinese adults.

BACKGROUND: Although tooth loss appears to be related to functional limitations, the mechanisms that underpin this relationship are unknown. We sought to address this knowledge gap by examining a multiple mediation hypothesis whereby tooth loss is predicted to indirectly affect functional limitations through social participation, subjective well-being, and cognitive function. METHODS: This study included 7,629 Chinese adults from the 2017/2018 Chinese Longitudinal Healthy Longevity Survey wave. The serial mediation effects were examined using Model 6 in the Hayes' PROCESS macro for SPSS. RESULTS: Tooth loss was significantly related to functional limitations. There was a direct (ß = - 0.0308; 95% CI, - 0.0131 to - 0.0036) and indirect (ß = - 0.0068; 95% CI, - 0.0096 to - 0.0041) association between tooth loss and instrumental activities of daily living (IADL) limitations, but only an indirect correlation with activities of daily living (ADL) limitations (ß = - 0.0188; 95% CI, - 0.0259 to - 0.0121). Social participation, subjective well-being, and cognitive function serially mediated the relationship between tooth loss and ADL/IADL limitations. CONCLUSION: The association between tooth loss and functional limitations is serially mediated by social participation, subjective well-being, and cognitive function. Our findings underscore the necessity of considering psychological and social factors as integrated healthcare approaches for the functional health of older adults.

Associations of educational attainment with Sepsis mediated by metabolism traits and smoking: a Mendelian randomization study.

Objective: Sepsis constitutes a significant global healthcare burden. Studies suggest a correlation between educational attainment and the likelihood of developing sepsis. Our goal was to utilize Mendelian randomization (MR) in order to examine the causal connection between educational achievement (EA) and sepsis, while measuring the mediating impacts of adjustable variables. Methods: We collected statistical data summarizing educational achievement (EA), mediators, and sepsis from genome-wide association studies (GWAS). Employing a two-sample Mendelian randomization (MR) approach, we calculated the causal impact of education on sepsis. Following this, we performed multivariable MR analyses to assess the mediation proportions of various mediators, including body mass index (BMI), smoking, omega-3 fatty acids, and apolipoprotein A-I(ApoA-I). Results: Genetic prediction of 1-SD (4.2 years) increase in educational attainment (EA) was negatively correlated with sepsis risk (OR = 0.83, 95% CI 0.71 to 0.96). Among the four identified mediators, ranked proportionally, they including BMI (38.8%), smoking (36.5%), ApoA-I (6.3%) and omega-3 (3.7%). These findings remained robust across a variety of sensitivity analyses. Conclusion: The findings of this study provided evidence for the potential preventive impact of EA on sepsis, which may be influenced by factors including and metabolic traits and smoking. Enhancing interventions targeting these factors may contribute to reducing the burden of sepsis.

Can mindfulness facilitate posttraumatic growth in breast cancer patients? The mediating role of illness perceptions and positive emotions.

The current observational study aimed to examine the relationship between mindfulness and posttraumatic growth (PTG) among patients with breast cancer. Additionally, it explores the mediating role of illness perceptions and positive emotions. A total of 697 women with breast cancer were recruited from four clinical sites as part of the Bounce project in Finland, Portugal, Italy, and Israel. The study measures were mindfulness (MAAS), illness perceptions (IPQ), positive affect (PANAS), and post-traumatic growth (PTGI) at three time points: near the time of diagnosis, 6 months, and 12 months post-diagnosis. A higher level of mindfulness was associated with perceptions of the illness as less chronic. Specifically, the perception of a limited timeline of breast cancer was associated with positive emotions, thus leading to enhanced PTG. Emphasis should be placed on promoting mindfulness, elaborating on illness perceptions, and maintaining positive affect as part of clinical interventions for PTG among breast cancer patients.

Serum 25-hydroxyvitamin D mediates the association between heavy metal exposure and cardiovascular disease.

BACKGROUND: Mediation analysis aims to determine how intermediate variables affect exposure to disease. In this study, 25-hydroxyvitamin D (25(OH)D) was evaluated to assess its role in mediating heavy metal exposure and cardiovascular disease (CVD). METHODS: A total of 9,377 participants from the National Health and Nutrition Examination Survey (NHANES) for the years 2011-2018 were included. Firstly, restricted cubic spline (RCS), and multivariable logistic regression model were performed to estimate the association between heavy metal exposure (Cadmium, Lead, Mercury, Manganese, and Selenium), as well as serum 25(OH)D and CVD. Secondly, using generalized linear regression model and generalized additive models with smooth functions, we investigated the correlation between heavy metal exposure and serum 25(OH)D. Finally, the mediation effect of serum 25(OH)D in the associations between heavy metal exposure and CVD was explored. RESULTS: The RCS plots revealed that Cadmium, and Lead were positively and linearly associated with CVD, while Mercury, and Manganese were inversely and linearly associated with CVD. Additionally, a roughly L- and U-shaped relationship existed between Selenium, as well as 25(OH)D and CVD. When potential confounding factors were adjusted for, serum 25(OH)D had negative associations with Cadmium, Lead, and Manganese, while serum 25(OH)D had positive relationship with Selenium. There was a mediation effect between Manganese exposure and CVD, which was mediated by 25(OH)D. CONCLUSION: According to the mediation analysis, the negative association between Manganese exposure and incident CVD was increased by 25(OH)D. The increasing dietary intake of Vitamin D could increase the protective effect of manganese intake on CVD.

Revealing the role of the gut microbiota in enhancing targeted therapy efficacy for lung adenocarcinoma.

Lung adenocarcinoma (LUAD) is the leading cause of cancer-related death globally. Although the gut microbiota's role in the antitumor efficacy of many cancers has been revealed, its involvement in the response to gefitinib therapy for LUAD remains unclear. To fill this gap, we conducted a longitudinal study that profiled gut microbiota changes in PC-9 tumor-bearing mice under different treatments, including gefitinib monotherapy and combination therapies with probiotics, antibiotics, or Traditional Chinese Medicine (TCM). Our findings demonstrated that combining probiotics or TCM with gefitinib therapy outperformed gefitinib monotherapy, as evidenced by tumor volume, body weight, and tumor marker tests. By contrast, antibiotic intervention suppressed the antitumor efficacy of gefitinib. Notably, the temporal changes in gut microbiota were strongly correlated with the different treatments, prompting us to investigate whether there is a causal relationship between gut microbiota and the antitumor efficacy of gefitinib using Mediation Analysis (MA). Finally, our research revealed that thirteen mediators (Amplicon Sequence Variants, ASVs) regulate the antitumor effect of gefitinib, regardless of treatment. Our study provides robust evidence supporting the gut microbiota's significant and potentially causal role in mediating gefitinib treatment efficacy in mice. Our findings shed light on a novel strategy for antitumor drug development by targeting the gut microbiota.

Larger hypothalamic subfield volumes in patients with chronic insomnia disorder and relationships to levels of corticotropin-releasing hormone.

The hypothalamus is a well-established core structure in the sleep-wake cycle. While previous studies have not consistently found whole hypothalamus volume changes in chronic insomnia disorder (CID), differences may exist at the smaller substructural level of the hypothalamic nuclei. The study aimed to investigate the differences in total and subfield hypothalamic volumes, between CID patients and healthy controls (HCs) in vivo, through an advanced deep learning-based automated segmentation tool. A total of 150 patients with CID and 155 demographically matched HCs underwent T1-weighted structural magnetic resonance scanning. We utilized FreeSurfer v7.2 for automated segmentation of the hypothalamus and its five nuclei. Additionally, correlation and causal mediation analyses were performed to investigate the association between hypothalamic volume changes, insomnia symptom severity, and hypothalamus-pituitary-adrenal (HPA) axis-related blood biomarkers. CID patients exhibited larger volumes in the right anterior inferior, left anterior superior, and left posterior subunits of the hypothalamus compared to HCs. Moreover, we observed a positive association between blood corticotropin-releasing hormone (CRH) levels and insomnia severity, with anterior inferior hypothalamus (a-iHyp) hypertrophy mediating this relationship. In conclusion, we found significant volume increases in several hypothalamic subfield regions in CID patients, highlighting the central role of the HPA axis in the pathophysiology of insomnia.

Why Are Adolescent Cannabis Use Disorder Treatment Admissions Declining in the US? The Mediated Pathway of State Treatment Admissions Rates before and after Recreational Cannabis Legalization.

Purpose: State-level prevalence data are used to investigate whether recreational cannabis legalization moderates the mediated pathway from the perception of low risk of harm, to cannabis use, to cannabis use disorder (CUD) treatment admissions, among adolescents (age 12-17) in the US. Methods: Annual state prevalence measures of perception of low risk, cannabis use, and CUD treatment admissions between 2008 and 2019 (N = 542 state-year observations) were collected from the National Survey on Drug Use and Health (NSDUH) and the Treatment Episode Dataset - Admissions (TEDS-A). A two-way fixed effects (state and year) moderated mediation model was used to test whether recreational legalization moderated the indirect effect of perception of low risk on treatment admissions via cannabis use. Results: A positive indirect effect of perceiving cannabis as low risk on CUD treatment admissions via cannabis use was observed prior to legalization but not afterwards. After legalization, the positive association of perceiving cannabis as low risk with cannabis use was strengthened, and the positive association of cannabis use with treatment admissions was suppressed, as compared to before legalization. Discussion: Recreational legalization may alter the social acceptability and medical self-administration of cannabis, potentially leading to CUD treatment utilization decline among adolescents even as risk factors for CUD increase. Linking recreational cannabis legalization to advancing awareness of the health risks associated with adolescent cannabis use and promoting adolescent CUD treatment engagement through mHealth approaches and primary care providers are key to addressing potential adolescent health challenges brought about by expanding cannabis legalization.

The holistic nursing competence and transition shock of newly graduated nurses as the determinants of missed nursing care: The mediation analysis.

AIMS AND OBJECTIVE: To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care. BACKGROUND: Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence. DESIGN: Descriptive and correlational design. METHODS: The study was conducted among newly graduated nurses (n = 201) working in acute care hospitals for 1-12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist. RESULTS: The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care. CONCLUSIONS: Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses. RELEVANCE TO CLINICAL PRACTICE: The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education.

Racial Disparities in COVID-19 Severity Are Partially Mediated by Chronic Stress-Evidence from a Large Integrated Healthcare System.

BACKGROUND: Racial and ethnic minorities have experienced a disproportionate burden of severe COVID-19. Whether chronic stress, also disproportionately experienced by racial and ethnic minorities, explains this excess risk is unknown. METHODS: We identified 9577 adults (≥ 18 years) diagnosed with COVID-19 from January 1, 2020, through September 30, 2021, enrolled in Kaiser Permanente Georgia (KPGA) with complete biomarker data. Self-reported race (Black or White) was defined from electronic medical records. Chronic stress, defined as allostatic load (AL), a composite score (scale 0-7) based on seven cardio-metabolic biomarkers, was categorized as below (low AL) or above (high AL) the median. Severe COVID-19 was defined as hospitalization or mortality within 30 days of COVID-19 diagnosis. The association between race, AL, and severe COVID-19 was assessed using multivariable Poisson regression. The mediating effect of AL was assessed using the Valeri and VanderWeele method. All results were expressed as risk ratios (RRs) with 95% confidence intervals. RESULTS: Overall, Black (vs. White) KPGA members had an 18% excess risk of AL (RR: 1.18, 95%CI: 1.14-1.23) and a 24% excess risk of severe COVID-19 (RR: 1.24, 95%CI: 1.12, 1.37). AL explained 23% of the Black-White disparities in severe COVID-19. CONCLUSIONS: In our study, chronic stress, characterized by AL, partially mediated Black-White disparities in severe COVID-19 outcomes.

The effect of acupuncture on exercise capacity in patients with COPD is mediated by improvements of dyspnea and leg fatigue: a causal mediation analysis using data from a randomized controlled trial.

BACKGROUND: Acupuncture is known to improve exercise capacity in patients with chronic obstructive pulmonary disease (COPD), but its mechanism remains unknown. Whether acupuncture improves exercise capacity in patients with COPD through alleviation of leg fatigue and dyspnea is examined by applying causal mediation analysis to previous trial data. METHODS: Sixty-two patients with COPD completed treatments with either real or placebo acupuncture once a week for 12 weeks. Walk distance measured using the 6-minute walk test and intensities of leg fatigue and dyspnea in the modified Borg scale were evaluated at baseline and after treatment. The intervention effect of acupuncture against the placebo acupuncture on two mediators, changes in leg fatigue and dyspnea, and whether they mediated improvements in walk distance, were analyzed. RESULTS: Linear regression analysis showed that the unstandardized regression coefficients [95% confidence interval (CI)] for the intervention effect by acupuncture were -4.9 (-5.8--4.0) in leg fatigue and -3.6 (-4.3--2.9) in dyspnea. Mediation analysis showed that when changes in leg fatigue were considered as a mediator, direct effect, indirect effect and proportion mediated were 47.1 m (95% CI, 4.6-85.1), 34.3 m (-2.1-82.1), and 42.1%, respectively, and when changes in dyspnea were considered as a mediator, they were 9.8 m (-32.9-49.9), 72.5 m (31.3-121.0), and 88.1%, respectively, and the effects of joint mediator were -5.8 m (-55.4-43.9), 88.9 m (32.7-148.5), and 107.0%, respectively. CONCLUSION: The improvement in exercise capacity by acupuncture is explained by changes in both leg fatigue and dyspnea.

When depressed-be mindful of and kind to yourself: Self-compassion as mediator of change in a mindful depression treatment.

Self-compassion as an outcome and potential mediator in mindfulness-based interventions has gained increased attention in the last years. However, most mediation studies had several methodological shortcomings which precluded robust conclusions regarding its mediating role. This randomized controlled study aimed to address these issues by assessing self-compassion, as proposed mediator and outcome, in a temporal sequence.Eighty-one patients with current depression and work-related conflicts were randomly assigned to either an eight-week mindfulness-based day hospital treatment (MDT-DH; n = 47; including psychopharmacological treatment if necessary) or a waitlist control condition including a psychopharmacological consultation (PCC; n = 34). The outcome, depression severity, was assessed before, at mid-treatment and after the treatment while the proposed mediator, self-compassion, was measured at two week-intervals from before treatment until directly after treatment. Within-person and between-person mediation effects were analysed using multilevel structural equation modelling.The results from the mediation models show that self-compassion (as a general factor) and two of its components (mindfulness of personal suffering and common humanity) increased and mediated the change in depressive symptoms over time.This study provides preliminary support for self-compassion as a mediator of treatment effects on depression in a mindful depression treatment.

Longitudinal association of mindfulness with aggression and non-suicidal self-injury in adolescence: The mediating role of shame-proneness.

The aim of the current study was to investigate the longitudinal association of facets of mindfulness with aggression and non-suicidal self-injury (NSSI) among adolescents and to explore whether shame-proneness can mediate the longitudinal association. The present longitudinal study investigated the associations between mindfulness, aggression, and NSSI in a sample of 706 Chinese adolescents (M = 15.33; SD = 1.34; 50.20% girls). Five facet mindfulness questionnaire was completed at baseline and middle school students' shame scale was completed at 6-month follow-up. The Chinese version of Buss-Perry aggression questionnaire and adolescents' self-harm scale were completed at both baseline and 6-month follow-up. Shame-proneness significantly mediated the longitudinal association between (a) describing and aggression (-0.107, 95% CI: [-0.151 to -0.067]), and NSSI (-0.041, 95% CI: [-0.069 to -0.019]). (b) Acting with awareness and aggression (-0.094, 95% CI: [-0.139 to -0.061]), and NSSI (-0.036, 95% CI: [-0.062 to -0.016]). (c) Nonjudging and aggression (-0.062, 95% CI: [-0.107 to -0.024]) and NSSI (-0.024, 95% CI: [-0.047 to -0.008]). Describing, acting with awareness, and nonjudging were predictive factors of aggression and self-injury in adolescents, and shame-proneness played a crucial role in the negative longitudinal association between them. Findings from the current study may offer some implications in the domains of clinical practice and education to improve mental health and further ameliorate the misbehavior among adolescents.

Mindful attention is inversely associated with pain via mediation by psychological distress in orthopedic patients.

BACKGROUND: Orthopedic patients report pain as their main symptom complaint. Subjective pain experience is correlated with self-reported psychological state, such as distress. PURPOSE: This study tests whether scores from a measure of mindful attention are associated with subjective pain levels and whether psychological distress scores function as a mediation path. METHODS: During routine visits to a single orthopedic clinic in East Los Angeles, California, 525 patients were recruited to participate in the study. Participants reported on measures of pain (Universal Pain Assessment Tool [UPAT]), mindful attention (Five-Facet Mindfulness Questionnaire [FFMQ]), and psychological distress (Depression, Anxiety, Stress Scale [DASS]). We used Pearson correlations to examine relationships between FFMQ and UPAT scores and mediation analyses to test indirect effects of DASS scores as a mediation path. RESULTS: The average age of the sample was 54 years (range 18-98 years), 61% were male, and 64% were non-Hispanic White individuals. The locations of injury were the shoulder (72%), elbow (21%), and clavicle or wrist (7%). Ninety-one percent reported mild or greater pain in the prior 2 weeks (mean = 4.2 ± 2.5, range 0-10), and 49% reported mild or more severe distress symptoms (DASS: 13.0 ± 11.5). FFMQ scores inversely predicted UPAT scores (ß = -0.22, P < .01), mediated through DASS scores. DASS subscale scores for depression (ß = -0.10, P = .02) and stress (ß = -0.08, P = .04) but not anxiety (ß = -0.03, P = .33) produced significant indirect effects. FFMQ acting-with-awareness and non-judging subscales had the largest effect on depression and stress DASS subscale scores. CONCLUSIONS: We find statistical support to suggest that distress-particularly depressed mood and stress-mediates the association between mindful attention and pain intensity among orthopedic patients. A disposition of mindful attention might counter distress ailments that exacerbate subjective pain, and this has possible implications for mindfulness training interventions offered to orthopedic patients.

Work Productivity Among Younger Breast Cancer Survivors: The Impact of Behavioral Interventions for Depression.

OBJECTIVES: The Pathways to Wellness randomized controlled trial found that 2 behavioral interventions, mindfulness awareness practices and survivorship education, reduced depressive symptoms in younger breast cancer survivors (BCSs) compared with wait-list control. This secondary analysis examines whether the interventions led to reduced loss of work productivity among younger BCSs and whether such reductions were mediated by reductions in depressive symptoms. METHODS: The Work Productivity and Activity Impairment scale was used to measure work productivity loss at 4 assessment time points. Correlates of productivity loss at enrollment were examined using multivariable linear regression. Differences in change over time in productivity loss between each intervention group and control were assessed using linear mixed models. Reduced depressive symptoms were tested as a mediator of reduced productivity loss. RESULTS: Of 247 trial participants, 199 were employed and included in the analyses. At enrollment, higher productivity loss was associated with chemotherapy receipt (P = .003), younger age (P = .021), more severe cognitive problems (P = .002), higher musculoskeletal pain severity (P = .002), more depressive symptoms (P = .016), and higher fatigue severity (P = .033). The mindfulness intervention led to significantly less productivity loss compared with control at all 3 postintervention assessment points (all P < .05), with about 54% of the effect mediated by reduction in depressive symptoms. Survivorship education was not associated with reduced loss of productivity. CONCLUSIONS: These findings suggest that addressing depressive symptoms through behavioral interventions, such as mindfulness, may mitigate impacts on work productivity in younger BCSs.

Dyadic association between mindfulness, family avoidance of communication about cancer and fear of cancer recurrence among breast cancer couples: A cross-sectional study.

PURPOSE: The research focused on examining the dyadic relationship between mindfulness, fear of cancer recurrence (FCR), and family avoidance of communication about cancer (FACC) within breast cancer couples. METHODS: This study utilized a cross-sectional approach to gather data from 249 breast cancer couples. Participants completed self-report measures assessing mindfulness, FCR, and FACC. The Actor-Partner Interdependence Mediation Model was applied to analyze how each individual's and their partner's mindfulness affected their own and their partner's FCR, as well as the mediating role of FACC in this relationship. RESULTS: The study found that the average FCR score for breast cancer patients was (32.59 ± 10.05), while their spouses had a score of (34.39 ± 8.60). The bootstrap method showed that self-FACC as a mediator between mindfulness in breast cancer couples and their own FCR (patient: ß = -0.044, P = 0.019; spouse: ß = -0.046, P = 0.007). Patients' FACC influenced the connection between their mindfulness and spouses' FCR (ß = -0.031, P = 0.030). CONCLUSIONS: The findings highlight the potential for interventions that focus on mindfulness and communication enhancement to alleviate FCR and improve the overall well-being of breast cancer couples.

O que pode uma câmera em sessões psicanalíticas com crianças com traços autistas? / What can do a camera do in psychoanalytic sessions with children with autistic traits? / Que peut apporter une caméra dans la prise en charge psychanalytiques des enfants autistes ? / ¿Qué puede hacer una cámara en sesiones psicoanalíticas con niños con rasgos autistas?

Resumo: A questão central que norteia este trabalho é se uma câmera de registro filmográfico, que é um objeto utilizado inicialmente com fins metodológicos, poderia ter uma função terapêutica. Objetiva-se apresentar e discutir as repercussões e possibilidades referentes à presença de uma câmera em atendimentos de casos de fechamento autístico no Programa de Intervenção Precoce, em uma perspectiva psicanalítica. É uma pesquisa clínico-qualitativa, com análise de conteúdo, a partir de vinhetas clínicas de três casos de crianças entre 2 e 3 anos. São discutidas três abordagens sobre os usos e os tipos de objetos pertencentes ao universo de um bebê, a fim de interrogar se elas poderiam auxiliar na clínica do autismo: objeto transicional, objeto tutor e objeto de mediação. Considerou-se que a câmera promoveu e sustentou encontros intersubjetivos importantes e o despertar da atenção de crianças, antes pouco interessadas por aquilo que lhes era ofertado, inaugurando um espaço de coconstrução e interludicidade.

Abstract: The central question that guides this work is about whether a film recording camera, which is an object initially used for methodological purposes, could have a therapeutic function. The aim is to present and discuss the repercussions and possibilities related to the presence of a camera in cases of autistic shutdown in the Early Intervention Program, from a psychoanalytic perspective. This is clinical-qualitative research, with content analysis, based on clinical vignettes of three cases of children, between 2 and 3 years old. Three approaches are discussed regarding the uses and types of objects belonging to a baby's universe, to ask if they could assist in the autism clinic: the transitional object, the tutor object, and the mediation object. It is considered that the camera promoted and sustained important intersubjective meetings and the awakening of children's attention, previously less interested in what was offered to them, initiating a space for co-construction and interludicity.

Résumé : La question centrale guidant ce travail porte sur l'éventuelle fonction thérapeutique d'une caméra, qui est un objet initialement utilisée à des fins méthodologiques. L'objectif est de présenter et de discuter, dans une perspective psychanalytique, les répercussions et les possibilités d'une caméra dans la prise en charge d'enfants présentant un repli autistique suivis au sein du Programme d'Intervention Précoce. C'est une recherche clinique-qualitative, avec analyse de contenu, à partir de vignettes cliniques de trois enfants, âgés de 2 à 3 ans. Trois approches concernant les usages et les types d'objets appartenant à l'univers d'un bébé seront repris, afin d'interroger s'ils pourraient aider à la clinique de l'autisme : l'objet transitionnel, l'objet tuteur et l'objet de médiation. Nous considérons que la caméra a favorisé et soutenu des rencontres intersubjectives importantes et a éveillé l'attention des enfants, auparavant peu intéressés par ce qui leur était offert, en créant un espace de co-construction et d'interludicité.

Resumen: La pregunta central que guía este trabajo gira en torno de la posibilidad de una cámara cinematográfica, un objeto inicialmente utilizado con fines metodológicos, para ser utilizada en sesiones terapéuticas. El objetivo es presentar y discutir las repercusiones y posibilidades relacionadas con la presencia de una cámara en la atención a casos de cierre autista en un Programa de Intervención Temprana, desde una perspectiva psicoanalítica. Se trata de una investigación clínico cualitativa, con análisis de contenido, a partir de viñetas clínicas de tres casos de niños, con edades de entre 2 y 3 años. Se discuten tres enfoques sobre los usos y tipos de objetos pertenecientes al universo de un bebé para observar si esto podría ayudar en la clínica del autismo: el objeto transicional, el objeto tutor y el objeto mediador. Se considera que la cámara promovió y sostuvo importantes encuentros intersubjetivos y el despertar de la atención de niños previamente poco interesados en lo que se les ofrecía, inaugurando un espacio de coconstrucción e interjuego.

Maternal obesity and childhood asthma risk: Exploring mediating pathways.

BACKGROUND: Growing evidence for the effect of maternal obesity on childhood asthma motivates investigation of mediating pathways. OBJECTIVE: To investigate if childhood body mass index (BMI), gestational weight gain (GWG) and preterm birth mediate the association of maternal obesity on childhood asthma risk. METHODS: We used electronic medical records from mother-child pairs enrolled in Kaiser Permanente Northern California integrated healthcare system. Children were followed from their birth (2005-2014) until at least age 4 (n = 95,723), age 6 (n = 59,230) or age 8 (n = 25,261). Childhood asthma diagnosis at each age was determined using ICD-9/10 codes and medication dispensings. Prepregnancy BMI (underweight [<18.5], normal [18.5-24.9], overweight [25-29.9], obese [≥30] kg/m2 ) were defined using height and weight measurements close to the last menstrual period date. Child's BMI (Centers for Disease Control and Prevention BMI-for-age percentiles: underweight [<5th], normal [5th-85th], overweight [85th-95th], obese [>95th]) were obtained using anthropometric measurements taken the year preceding each follow-up age. GWG (delivery weight-prepregnancy weight) was categorised based on Institutes of Medicine recommendations (inadequate, adequate, excessive). Implementing first causal inference test (CIT) then causal mediator models (to decompose the natural direct and indirect effects), we examined the potential mediating effect of childhood BMI, GWG, and preterm birth on the association between prepregnancy BMI (continuous and categorical) and childhood asthma. RESULTS: Overall, risk of childhood asthma increased as prepregnancy BMI increased (age 4 risk ratio: 1.07, 95% confidence interval: 1.04, 1.09, per 5 kg/m2 increase in BMI; similar for age 6 and 8). CIT identified childhood BMI and preterm birth, but not GWG as potential mediators. Causal mediation models confirmed childhood BMI, but not preterm birth, as having a partial mediating effect. Results were similar for age 6 and 8, and when continuous mediators (instead of binary) were assessed. CONCLUSIONS: Childhood overweight/obesity has a modest mediating effect on the association between prepregnancy BMI and childhood asthma.