Psychological pathway to emotional exhaustion among nurses and midwives who provide perinatal bereavement care in China: a path analysis.

BACKGROUND: A lack of confidence in perinatal bereavement care (PBC) and the psychological trauma experienced by nurses and midwives during bereavement care leads to their strong need for sufficient organisational support. The current study intended to test a hypothesised model of the specific impact paths among organisational support, confidence in PBC, secondary traumatic stress, and emotional exhaustion among nurses and midwives. METHODS: A descriptive, cross-sectional survey was conducted in sixteen maternity hospitals in Zhejiang Province, China, from August to October 2021. The sample (n = 779) consisted of obstetric nurses and midwives. A path analysis was used to test the relationships among study variables and assess model fit. RESULTS: Organisational support directly and positively predicted confidence in PBC and demonstrated a direct, negative, and significant association with secondary traumatic stress and emotional exhaustion. Confidence in PBC had a positive direct effect on secondary traumatic stress and a positive indirect effect on emotional exhaustion via secondary traumatic stress. Secondary traumatic stress exhibited a significant, direct effect on emotional exhaustion. CONCLUSIONS: This study shows that nurses' and midwives' confidence in PBC and mental health were leadingly influenced by organisational support in perinatal bereavement practice. It is worth noting that higher confidence in PBC may lead to more serious psychological trauma symptoms in nurses and midwives. Secondary traumatic stress plays an essential role in contributing to emotional exhaustion. The findings suggest that support from organisations and self-care interventions were required to improve confidence in PBC and reduce negative psychological outcomes among those providing PBC. The development of objective measures for assessing competence in PBC and organizational support are essential.

When perfectionists adopt health behaviors: perfectionism and self-efficacy as determinants of health behavior, anxiety and depression.

BACKGROUND: The study aims to show interrelations between self-efficacy, perfectionism (adaptive and maladaptive), health behavior, and mental health outcomes such as anxiety and depression as an exponent in maintaining optimal health. In the analyses, we focused on one category of health behaviors - preventive practices.: participants and procedure: Of the gathered data, 295 complete datasets were analyzed (age: M = 28.16, SD = 9.41; 72.8% participants female). We proposed two path models with personality traits (as exogenous variables) and health behaviors (as endogenous variables) in predicting depression and anxiety. RESULTS: Multiple regression analysis revealed that maladaptive perfectionism and generalized self-efficacy significantly predicted health behaviors in general and mental health outcomes whereas adaptive perfectionism and generalized self-efficacy were significant predictors of preventive practices. The path analyses showed that generalized self-efficacy and perfectionism are related directly to mental health outcomes as well as indirectly, through health behaviors. Interestingly, we found a negative indirect effect of an interaction between generalized self-efficacy and preventive practices as well as of an interaction between adaptive perfectionism and preventive practices on mental health outcomes. The model fitted well with the data. CONCLUSIONS: The findings show that a balanced and more holistic approach to maintaining health is beneficial for people high in self-efficacy in comparison with high focus on disease prevention. Additionally, the results demonstrate that adaptive perfectionists and people high in self-efficacy may also be prone to anxiety and depression (not just maladaptive perfectionists) when their health focus is too narrow.

The associations between spiritual well-being, hope and psychological symptoms in Chinese childhood cancer patients: A path analysis.

AIMS: We aimed to test a model in which hope and spiritual well-being acted as protective factors against anxiety and depressive symptoms in childhood cancer patients (CCPs). We hypothesized that hope and spiritual well-being were mutually reinforcing factors that would both reduce anxiety and depressive symptoms. METHODS: Using path analysis, the hypothetical model was tested on a cross-sectional sample of 412 Chinese CCPs aged 8-17 years. Self-reported measures were used to obtain data on participants' social and clinical characteristics, spiritual well-being, hope, anxiety and depressive symptoms. RESULTS: The hypothetical model was supported. Results suggested that sex, treatment type and diagnosis predicted spiritual well-being; diagnosis and time since diagnosis predicted hope. Spiritual well-being and hope were mutually predictive and mutually reinforcing, and were both negatively associated with anxiety and depressive symptoms. This model predicted 40% of the variance in spiritual well-being, 37% in hope, 39% in depressive symptoms, and 28% in anxiety. CONCLUSION: Spiritual well-being and hope were mutually reinforcing and served as protective factors against anxiety and depressive symptoms. These support the value for integrating spiritual and hope elements in developing interventions for CCPs to improve their spiritual and psychological well-being along the disease trajectory.

Pollen as the link between floral phenotype and fitness.

Pollen plays a key role in plant reproductive biology. Despite the long history of research on pollen and pollination, recent advances in pollen-tracking methods and statistical approaches to linking plant phenotype, pollination performance, and reproductive fitness yield a steady flow of exciting new insights. In this introduction to the Special Issue "Pollen as the Link Between Phenotype and Fitness," we start by describing a general conceptual model linking functional classes of floral phenotypic traits to pollination-related performance metrics and reproductive fitness. We use this model as a framework for synthesizing the relevant literature, highlighting the studies included in the Special Issue, and identifying gaps in our understanding and opportunities for further development of the field. The papers that follow in this Special Issue provide new insights into the relationships between pollen production, presentation, flower morphology, and pollination performance (e.g., pollen deposition onto stigmas), the role of pollinators in pollen transfer, and the consequences of heterospecific pollen deposition. Several of the studies demonstrate exciting experimental and analytical approaches that should pave the way for continued work addressing the intriguing role of pollen in linking plant phenotypes to reproductive fitness.

Determinants of length for age Z scores among children aged 6-23 months in Central Java, Indonesia: a path analysis.

Introduction: Length for Age Z (LAZ) score determinants are complex and vary among different areas, but it is important for designing effective and efficient strategies to decrease stunting prevalence among children under 2 years. This study aimed to investigate the determinants of LAZ scores among children under 2 years in Central Java, Indonesia. Methods: This study was conducted on the 2021 Indonesian Nutritional Status Study (INSS) dataset, which was a cross-sectional survey. Data on 3,430 children aged 6-23 months from Central Java province were derived from the 2021 INSS data. After missing data elimination, 3,238 subjects were included in the analysis. Determinant factors included direct and indirect factors. Direct factors were the mother's age, birth weight Z score (BWZ), birth length Z score (BLZ), exclusively breastfed history, dietary diversity scores (DDS), empty calorie drink consumption, unhealthy snacks consumption, and infections. Indirect factors were early initiation of breastfeeding (EIBF) and posyandu (integrated health post) utilization. Underlying factors were socioeconomic status (SES) and the mother's education. Bivariate analyses and multiple linear regressions were conducted. A path analysis with a hypothesized model based on the UNICEF conceptual framework was also performed. Results: Stunting, wasting and underweight proportions among the subjects were 19.1%, 7.6% and 12.3%, respectively. The mean LAZ scores were -0.95 ± 1.22; the mother's age was 29.7 ± 5.95 years; BWZ was -0.47 ± 0.97; BLZ was -0.55 ± 1.05; and DDS was 4.45 ± 1.51. The infection proportion among the subjects was 28%. BWZ and BLZ were positively correlated to LAZ scores, with r = 0.267 (p < 0.01) and r = 0.260 (p < 0.01), respectively. The mother's age was negatively correlated to LAZ scores with r = -0.041 (p < 0.05). Maternal education was positively correlated to SES but had no direct effect on LAZ scores. LAZ score determinants of BLZ (p < 0.001) and SES (p < 0.001) showed positive direct associations with LAZ scores, but the mother's age (p = 0.039), exclusively breastfed history (p < 0.001), and empty calorie drinks consumption (p < 0.001) had negative associations with LAZ scores. Conclusion: To prevent stunting among children aged 6-23 months in Central Java, Indonesia, intervention programs to increase the nutritional status of women at child-bearing age and nutrition education on child feeding practices should be conducted more efficiently and effectively.

Proanthocyanidin Structure-Activity Relationship Analysis by Path Analysis Model.

To fully explore the influence mechanism of interactions between different monomer units of proanthocyanidins (PAs) on biological activity, a path analysis model of the PA structure-activity relationship was proposed. This model subdivides the total correlation between each monomer unit and activity into direct and indirect effects by taking into account not only each monomer unit but also the correlation with its related monomer units. In addition, this method can determine the action mode of each monomer unit affecting the activity by comparing the direct and total indirect effects. Finally, the advantage of this model is demonstrated through an influence mechanism analysis of Rhodiola crenulata PA monomer units on antioxidant and anti-diabetes activities.

A path analysis to investigate the interaction between serum, urinary and demographic factors influencing urine calcium in kidney stone formers.

BACKGROUND: Hypercalciuria is one of the most important urinary risk factors in kidney stone formers. This study aimed to delineate the interaction of some demographic, serum, and urinary risk factors influencing 24-h urinary (24-U) calcium excretion. METHODS: This study was secondary data analysis, using data from 593 kidney stone patients referred to the Labbafinejad kidney stone prevention clinic from March 2015 to May 2019. The study considered serum, urinary and demographic factors that interact to influence 24-U calcium using path analysis. In addition to the direct impact of predictors on the 24-U calcium, this analysis considered the effects of the predictors on the 24-U calcium transmitted by a mediating variable named indirect effects. RESULTS: The results showed that age indirectly affected on 24-U calcium through 25-hydroxy vitamin D (25(OH)D), serum and 24-U creatinine. As well, weight had an indirect effect through 24-urine metabolites (creatinine, citrate, urea, and sodium). Among serum variables, PTH and creatinine significantly directly affected on 24-U calcium. In comparison, 25(OH)D and phosphorus appeared to influence 24-U calcium indirectly through serum parathormone. Regarding 24-U metabolites, sodium, urea, and citrate had a significant direct effect on 24-U calcium. Moreover, 24-U creatinine has a significant direct and indirect effect on 24-U calcium through citrate and urea as mediator variables. CONCLUSION: Serum 25(OH)D and phosphorus, along with age and weight, indirectly affected urinary calcium through a third variable. Other variables (PTH, serum creatinine, and 24-U sodium, urea, and citrate) showed a direct effect on 24-U calcium excretion.

[Accumulation, Migration, and Transformation of Soil Phosphorus in Facility Agriculture and Its Influencing Factors].

The aim of this study was to apply phosphorus fertilizer scientifically and reasonably and reduce the pollution risk to the facility agricultural environment. Taking the facility agriculture concentration area in Daxing District of Beijing as the research object, the phosphorus content in soil (0-100 cm) of the facility agriculture profile with different planting years was measured and analyzed to explore the characteristics of phosphorus accumulation, migration, and transformation. The results showed that the contents of total phosphorus and available phosphorus in the surface soil of facility agriculture varied widely, which was significantly higher than that in the surrounding grain field soil, which was mainly related to the amount of phosphorus applied by farmers in different planting years. With the increase in soil depth, the contents of total phosphorus and available phosphorus decreased gradually, showing surface aggregation ω (total phosphorus) ranging from 0.38 to 2.58 g·kg-1 and ω (available phosphorus) ranging from 1.60 to 256.00 mg·kg-1. With the increase in planting years, the contents of soil total phosphorus and available phosphorus first increased and then decreased, reached a peak in approximately 15 years, then gradually decreased, tended to be stable, and generally remained at a high level. Inorganic phosphorus was mainly concentrated in the surface soil of the facility agriculture, in which Ca-P accounted for the largest proportion of inorganic phosphorus, up to 98.38%; Ca10-P was the main form of Ca-P, up to 78.70% of Ca-P, and Ca2-P accounted for the smallest proportion, only 9.50% of Ca-P. The contents of different forms of inorganic phosphorus showed the vertical distribution characteristics of enrichment in the surface soil and a decrease downward. There were differences in the proportion of different forms of inorganic phosphorus to total phosphorus in different soil depths, in which the change in Ca-P was obvious, whereas the change in Fe-P and 0-P was not significant, indicating that the migration and transformation of Fe-P and O-P in the facility agricultural soil was poor, and the migration and transformation of inorganic phosphorus was mainly Ca-P. According to the correlation and path analysis, the direct path coefficient of Ca2-P to available phosphorus was the largest (0.787), which was not only the main source of soil available phosphorus but also the main form of inorganic phosphorus migration and transformation. Under the condition of protected cultivation, soil phosphorus showed a large accumulation trend, the availability of Ca10-P was low, and the accumulation was large. How to improve this portion of phosphorus sources is the key to the management of protected soil phosphorus.

Analysis of trait-performance-fitness relationships reveals pollinator-mediated selection on orchid pollination traits.

PREMISE: The role of pollinators in evolutionary floral divergence has spurred substantial effort into measuring pollinator-mediated phenotypic selection and its variation in space and time. For such estimates, the fitness consequences of pollination processes must be separated from other factors affecting fitness. METHODS: We built a fitness function linking phenotypic traits of food-deceptive orchids to female reproductive success by including pollinator visitation and pollen deposition as intermediate performance components and used the fitness function to estimate the strength of pollinator-mediated selection through female reproductive success. We also quantified male performance as pollinarium removal and assessed similarity in trait effects on male and female performance. RESULTS: The proportion of plants visited at least once by an effective pollinator was moderate to high, ranging from 53.7% to 85.1%. Tall, many-flowered plants were often more likely to be visited and pollinated. Given effective pollination, pollen deposition onto stigmas tended to be more likely for taller plants. Pollen deposition further depended on traits affecting the physical fit of pollinators to flowers (flower size, spur length), though the exact relationships varied in time and space. Using the fitness function to assess pollinator-mediated selection through female reproductive success acting on multiple traits, we found that selection varied detectably among taxa after accounting for sampling uncertainty. Across taxa, selection on most traits was stronger on average and more variable when pollination was less reliable. CONCLUSIONS: These results support pollination-related trait-performance-fitness relationships and thus pollinator-mediated selection on traits functionally involved in the pollination process.

Who am I as a Sexual Being? The Role of Sexual Self-Concept Between Dispositional Mindfulness and Sexual Satisfaction among Child Sexual Abuse Survivors.

Childhood sexual abuse (CSA) is associated with long-lasting and pervasive impacts on survivors' sexual health, particularly on their sexual satisfaction. Dispositional mindfulness has been found to be associated with greater sexual satisfaction among adult CSA survivors. However, the mechanisms involved in this association remain understudied. The present study examined the role of sexual self-concept (i.e., sexual esteem, sexual preoccupation, and sexual depression) in the relationship between dispositional mindfulness and sexual satisfaction among CSA survivors. A total of 176 adult CSA survivors (60.6% women, 39.4% men) completed an online survey assessing dispositional mindfulness, sexual self-concept, and sexual satisfaction. Path analyses revealed that dispositional mindfulness was positively related to sexual satisfaction through a significant indirect effect of higher sexual esteem and lower sexual depression. The integrative model explained 66.5% of the variance in sexual satisfaction. These findings highlight the key roles that dispositional mindfulness and sexual self-concept play in CSA survivors' sexual satisfaction. Implications for interventions based on trauma-sensitive mindfulness targeting the sexual self-concept are discussed, as they may promote sexual satisfaction in adult CSA survivors.

Long-term risk factors for old-age social exclusion in Sweden: a 30-year longitudinal study.

PURPOSE OF THE RESEARCH: Social exclusion threatens quality of life in older age. However, there is a lack of research on social exclusion from life-course and gender perspectives. We investigated early- and midlife risk factors for old-age social exclusion among women and men. MATERIALS AND METHODS: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over a 30-year period on 1,819 people at baseline. Indicators of economic exclusion, leisure/social exclusion, and civic exclusion were assessed at early late life (M=70 years) and late life (M=81). Educational attainment, non-employment, psychological health problems and mobility problems were measured as risk factors at midlife (M=54) and late midlife (M=61). Path analysis derived a model of old-age social exclusion. RESULTS: Exclusion on a domain in early late life led to exclusion on the same domain in late life, except for the economic domain. Leisure/social exclusion in early late life also led to civic exclusion in late life. Midlife risk factors influenced late-life exclusion almost exclusively through early late-life exclusion. While model fit could not be significantly improved by allowing coefficients to vary freely by gender, there was a stronger effect of non-employment on exclusion in women and a stronger effect of psychological health problems on exclusion in men. CONCLUSIONS: This study confirms that old-age exclusion is persistent and dynamic, and influenced by risk factors experienced earlier in life. A holistic approach with integrated efforts across different policy areas is needed to efficiently reduce old-age social exclusion.

Reduced vitamin D receptor (VDR) and cathelicidin antimicrobial peptide (CAMP) gene expression contribute to the maintenance of inflammatory immune response in leprosy patients.

Leprosy is an infectious disease influenced by genetic, immunological, and environmental factors. Reduced gene expressions may be associated with the immunological response pattern and leprosy susceptibility. We investigated the direct and indirect effects of Vitamin D Receptor (VDR) and Cathelicidin Antimicrobial Peptide (CAMP) gene expressions on the serum levels of vitamin D, Cathelicidin, and cytokines in newly-diagnosed leprosy patients and post-six-months of multidrug therapy (MDT). Thirty-four leprosy patients were assessed, paucibacillary (PB; n = 14) and multibacillary (MB; n = 20) cases, untreated or having received six months of MDT, 18 healthy controls, and 25 household contacts. VDR and CAMP gene expression levels were strongly correlated to some important cytokines in both, untreated leprosy patients (PB, r = 0.9319; MB, r = 0.9569) and patients who had undergone MDT (PB, r = 0.9667; MB, r = 0.9569). We observed that both gene expressions directly influenced IL-2, IFN-γ, and IL-17F serum levels in leprosy patients compared to the household contacts and healthy individuals. VDR and CAMP gene expressions induced a persistent inflammatory response in PB and MB leprosy patients, even after six months of MDT, to fight the Mycobacterium leprae infection. Due to the persistent inflammatory profile, multidrug therapy is suggested to be maintained for more than six months, especially for MB patients. Vitamin D supplementation is recommended from the onset as a transcription factor to improve VDR and CAMP gene expression in leprosy patients.

[Content of mineral elements in different Artemisia argyi germplasms and their relationship with quality properties].

To clarify the content characteristics of mineral elements in different Artemisia argyi germplasm resources and their relationship with the quality properties of Artemisiae Argyi Folium, this study measured the content of 10 mineral elements including nitrogen(N), phosphorus(P), potassium(K), calcium(Ca), magnesium(Mg), aluminum(Al), manganese(Mn), iron(Fe), copper(Cu), and zinc(Zn) in 100 Artemisia argyi germplasm samples. Besides, their relationship with the quality properties of Artemisiae Argyi Folium was explored by correlation analysis, path analysis, and cluster analysis. The results demonstrated that the variation coefficient of the 10 mineral elements in Artemisiae Argyi Folium ranged from 12.23% to 64.38%, and the genetic diversity index from 0.97 to 3.09. The genetic diversities of N, P, and Zn were obvious. As revealed by the correlation analysis, N, P, and K showed strong positive correlations with each other. Except that Mg and Al were negatively correlated, Ca, Mg, Al, Mn, Fe, Cu, and Zn were positively correlated. The correlation analysis of mineral elements with the quality properties of Artemisiae Argyi Folium proved the significant correlations of 17 pairs of characters. According to the path analysis, P, K, Ca, and Mn greatly affected the yield of Artemisiae Argyi Folium, P, K, and Mg the output rate of moxa, N, P, and K the content of total volatile oil, P and K the content of eucalyptol, and P, K, and Ca the content of eupatilin. The 100 germplasm samples were clustered into three groups. Specifically, in cluster Ⅰ, the enrichment capacity of P, K, and Mg elements was strong, and the comprehensive properties of mineral elements were better, implying good development potential. Ca, Mn, Fe, and Zn elements in cluster Ⅱ and N and Al in cluster Ⅲ displayed strong enrichment capacities. This study has provided new ideas for resource evaluation and variety breeding of A. argyi and also reference for fertilizer application.

Using Structural Equation Modeling to Untangle Pathways of Risk Factors Associated with Incident Type 2 Diabetes: the Lifelines Cohort Study.

Risk factors for type 2 diabetes are multifaceted and interrelated. Unraveling the complex pathways of modifiable risk factors related to incident type 2 diabetes will help prioritize prevention targets. The current analysis extended a previously proposed conceptual model by Bardenheier et al. (Diabetes Care, 36(9), 2655-2662, 2013) on prediabetes with a cross-sectional design. The model described the pathways of four aspects of modifiable risk factors in relation to incident type 2 diabetes, including socioeconomic status (income and education); lifestyle behaviors (diet quality, physical activity, TV watching, smoking, risk drinking, and unhealthy sleep duration); clinical markers (HDL-cholesterol, triglycerides, BMI, and waist circumference); and blood pressure. We performed structural equation modeling to test this conceptual model using a prospective population-based sample of 68,649 participants (35-80 years) from the Lifelines cohort study. During a median follow-up of 41 months, 1124 new cases of type 2 diabetes were identified (incidence 1.6%). The best-fitting model indicated that among all modifiable risk factors included, waist circumference had the biggest direct effect on type 2 diabetes (standardized ß-coefficient 0.214), followed by HDL-cholesterol (standardized ß-coefficient - 0.134). Less TV watching and more physical activity were found to play an important role in improving clinical markers that were directly associated with type 2 diabetes. Education had the biggest positive effects on all lifestyle behaviors except for unhealthy sleep duration. Our analysis provides evidence to support that structural equation modeling enables a holistic assessment of the interplay of type 2 diabetes risk factors, which not only allows the estimation of their total effects but also prioritization of prevention targets. Regarding the current guideline for diabetes prevention, waist management in addition to BMI control (clinical level), as well as less TV watching in addition to more physical activity (behavioral level), may provide additional public health benefits. Better education would be the main societal goal for the prevention of type 2 diabetes.

Distribution of soil available nutrients and their response to environmental factors based on path analysis model in arid and semi-arid area of northwest China.

The study on the distribution of soil available nutrients and their response to the natural environment can provide valuable data and theoretical guidance for supporting human agricultural activities, especially in arid and semi-arid area where the ecological environment is extremely fragile. Based on the soil sampling and survey data set, this study established the path analysis model of SANs (soil available nutrients, including ammonium nitrogen (AN), available phosphorus (AP) and available potassium (AK)) with topography, climate and vegetation in order to explore how environmental factors interact to affect the content of SANs. Then, we combined Pearson correlation analysis and statistical analysis to explore the distribution of SANs under different environmental conditions and the response of vegetation growth to climate changes, in order to further reveal the availability of soil nutrients. The results showed that vegetation was the most important direct factor affecting AN and AP, and AK was the most sensitive to climate changes. The indirect effects of topography and climate on SANs were much greater than their direct effects. Elevation largely predicted the change of climate environment, and the regional climate directly controlled the growth of vegetation. These indirect effects strengthened the connection between topography as well as climate factors and SANs. It is worth noting that the response of vegetation to temperature and precipitation had time lag, which would have a certain impact on the content of SANs response to the environmental changes. This study is of great significance for improved understanding of soil nutrients supply and how ecosystems respond to soil nutrients availability in arid and semi-arid area.

Bubble tea consumption and its association with mental health symptoms: An observational cross-sectional study on Chinese young adults.

BACKGROUND: Bubble tea has become enormously popular in China in recent years. This cross-sectional study investigated the association between bubble tea consumption and symptoms of anxiety and depression in a population-based sample. METHODS: Self-report questionnaires were used to assess bubble tea consumption and mental status. Symptoms of depression were assessed using the self-rated Patient Health Questionnaire-2 (PHQ-2) and anxiety using the self-rated Generalized Anxiety Disorder Scale-2 (GAD-2). Logistic regressions were performed to evaluate the association between the frequency of bubble tea consumption (cups/week) (FBTC) and psychological symptoms, adjusting for demographic and socioeconomic characteristics. Path analysis was used to investigate the possible meditating effects of confounding factors. RESULTS: After adjusting for potential confounding factors, high frequency of bubble tea consumption was observed to be significantly associated with high risk for depression in the regression model (p for trend = 0.045); no significant association was found with anxiety (p for trend = 0.332). In path analysis model, education mediated the association between FBTC and depression. Unlike the result in regression model, with education, exercise time and occupation as mediating factors, anxiety was found to be indirectly associated with FBTC. LIMITATIONS: Symptoms of depression and anxiety were self-reported. And the cross-sectional nature of the study does not allow inferring causality. CONCLUSIONS: Bubble tea consumption was associated with an increased risk of experiencing symptoms of depression and anxiety in Chinese young adults. Additional longitudinal research is required to elucidate the possible reverse causation from bubble tea consumption on symptoms of depression and anxiety.

Content of mineral elements in different Artemisia argyi germplasms and their relationship with quality properties / 中国中药杂志

To clarify the content characteristics of mineral elements in different Artemisia argyi germplasm resources and their relationship with the quality properties of Artemisiae Argyi Folium, this study measured the content of 10 mineral elements including nitrogen(N), phosphorus(P), potassium(K), calcium(Ca), magnesium(Mg), aluminum(Al), manganese(Mn), iron(Fe), copper(Cu), and zinc(Zn) in 100 Artemisia argyi germplasm samples. Besides, their relationship with the quality properties of Artemisiae Argyi Folium was explored by correlation analysis, path analysis, and cluster analysis. The results demonstrated that the variation coefficient of the 10 mineral elements in Artemisiae Argyi Folium ranged from 12.23% to 64.38%, and the genetic diversity index from 0.97 to 3.09. The genetic diversities of N, P, and Zn were obvious. As revealed by the correlation analysis, N, P, and K showed strong positive correlations with each other. Except that Mg and Al were negatively correlated, Ca, Mg, Al, Mn, Fe, Cu, and Zn were positively correlated. The correlation analysis of mineral elements with the quality properties of Artemisiae Argyi Folium proved the significant correlations of 17 pairs of characters. According to the path analysis, P, K, Ca, and Mn greatly affected the yield of Artemisiae Argyi Folium, P, K, and Mg the output rate of moxa, N, P, and K the content of total volatile oil, P and K the content of eucalyptol, and P, K, and Ca the content of eupatilin. The 100 germplasm samples were clustered into three groups. Specifically, in cluster Ⅰ, the enrichment capacity of P, K, and Mg elements was strong, and the comprehensive properties of mineral elements were better, implying good development potential. Ca, Mn, Fe, and Zn elements in cluster Ⅱ and N and Al in cluster Ⅲ displayed strong enrichment capacities. This study has provided new ideas for resource evaluation and variety breeding of A. argyi and also reference for fertilizer application.

Perceiving the Role of Communication Skills as a Bridge between the Perception of Spiritual Care and Acceptance of Evidence-Based Nursing Practice-Empirical Model.

Decision making using evidence-based practice (EBP) is generally universally accepted by nurses. Such acceptance may affect the personnel's behaviour towards patients, which is also demonstrated by taking into consideration the patient's preferences, including the patient's spiritual needs, in the care plan. The provision of such care requires the development of an attitude of approval and an adequate level of communicative competence, which will enable the actual implementation of the EBP. The purpose of our study was to assess the perception of spirituality and the nurse's role in providing spiritual care, as well as the perception of the significance of communication skills in the approval of EBP in professional practice. A multi-centre cross-section study was conducted on a population of 1176 participants (459 undergraduate (bachelor's programme, BP) and 717 postgraduate students (master's programme, MP)) from 10 medical universities in Poland. Three tools were used in the study to evaluate the participants' approach: Evidence-Based Practice Competence Questionnaire (EBP-COQ), The Spirituality and Spiritual Care Rating Scale (SSCRS), and Communication Skills Attitude Scale (CSAS). Structural equation modelling was used for the analysis. An analysis of structural equations revealed the presence of positive relationships of the attitude to spiritual care and the role of communicative competences with the approach to EBP regardless of the cohort. A significant difference was found related to the influence of age on the attitude towards learning communicative competences. The approval in this respect was observed to decrease with age in the MP group. Increasing approval of EBP requires strengthening the approach to activity-centred spiritual care, with the simultaneous development of a positive attitude towards learning communicative competences. The model reveals the need to integrate a humanistic approach with EBP, which can be achieved by planning different interventions in different groups of recipients: nurses, academic teachers and students.

Accept Anxiety to Improve Sleep: The Impact of the COVID-19 Lockdown on the Relationships between Mindfulness, Distress, and Sleep Quality.

It has been recently proposed that mindfulness can improve sleep quality through the mediating role on psychological distress and that acceptance may play a pivotal role in mindfulness beneficial effects. The aim of the present work was to understand the effects of the COVID-19 lockdown on dispositional mindfulness, sleep, and distress, and on their relationships. In particular, we wanted to test the hypothesis that the detrimental effects of lockdown on sleep depended on mindfulness and distress (including anxiety and depression) and that the acceptance facet of mindfulness played the leading role. A longitudinal study based on self-report questionnaires was conducted on 39 Italian adults (M age = 35.03, SD = 14.02; 21 men) assessing mindfulness, distress, and sleep quality before (23 December 2019-8 March 2020) and during (27 April 2020-10 May 2020) the first Italian COVID-19 lockdown. Lockdown decreased mindfulness while increasing distress and sleep problems. Path analysis showed that the effects of lockdown on sleep were fully mediated by mindfulness and distress. Furthermore, a more detailed analysis showed that these effects were mainly dependent on the acceptance component of mindfulness working through anxiety. The present study confirms, in the context of the COVID-19 lockdown, a model according to which mindfulness, and specifically acceptance, influences sleep through the mediating role of distress.

The Immediate Effect of Trigger Point Injection With Local Anesthetic Affects the Subsequent Course of Pain in Myofascial Pain Syndrome in Patients With Incurable Cancer by Setting Expectations as a Mediator.

A trigger point injection (TPI) with local anesthetic in myofascial pain syndrome (MPS) often has the immediate effect of a decrease in pain. It is unknown whether the immediate effect of a decrease in pain affects the subsequent course of pain. It is also unknown whether expectations of a decrease in pain mediate such effects. We aimed to clarify how the effect of a decrease in pain immediately after TPI with local anesthetic affected the subsequent course of pain, and whether it increased expectations of a decrease in pain. This was a prospective, single-center, observational clinical trial. Patients with incurable cancer who visited the palliative care department and received TPI with local anesthetic for MPS were prospectively examined. We evaluated whether the immediate effect of a TPI with local anesthetic affects the subsequent course of pain in MPS by setting expectations as a mediator, using path analysis. From 2018 to 2020, 205 patients with incurable cancer received TPI for MPS. Of these, 58.1% of patients reported an immediate effect of decreased pain. Compared with the non-immediate effect group, the immediate effect group had higher expectations of a decrease in pain, and the higher expectation was maintained at 7 days (p < 0.001). The percentage of patients with pain reduction at 7 days after TPI was 88.2% in the immediate effect group and 39.5% in the non-immediate effect group (p < 0.001). The immediate effect of decreased pain had the greatest influence on pain reduction at 7 days, both directly (ß = 0.194) and indirectly through increased expectations (ß = 0.293), as revealed by path analysis. The effect of a decrease in pain immediately after TPI with local anesthetic affected the subsequent course of MPS pain in patients with incurable cancer by setting expectations as a mediator. There were limitations to the discussion of these findings because this was an observational study.