People may experience anxiety and related distress when they come in contact with climate change (i.e., climate change anxiety). Climate change anxiety can be conceptualized as either emotional-based response (the experience of anxiety-related emotions) or impairment-based response (the experience of impairment in daily functioning). To date, it remains uncertain how these distinct manifestations of climate change anxiety are related. Conceptually, the experience of climate change anxiety may transform from an adaptive and healthy emotional response to an impairment in daily functioning. We conducted two two-wave longitudinal studies to examine the possible bidirectional relationships between three manifestations of climate change anxiety. We recruited 942 adults (mean age = 43.1) and 683 parents (mean age = 46.2) in Studies 1 and 2, respectively. We found that Time 1 emotion-based response was positively linked to Time 2 cognitive-emotional impairment, while Time 1 cognitive-emotional impairment was positively related to Time 2 functional impairment. In Study 2, we also found a bidirectional positive relationship between generalized anxiety and emotion-based climate change anxiety over time. Overall, our findings provide initial support to the temporal relationships between different manifestations of climate change anxiety, corroborating that climate change anxiety may develop from emotional responses to impairment in functioning.

BACKGROUND: Recognizing the established link between social determinants of health, such as social support, good governance, and perceived discrimination, and individual mental health, this study aims to delve deeper into the specific relationships within the Iranian adult population. It seeks to elucidate the potential mediating role of quality of life in the association between mental health disorders (MHDs) and these social factors.
METHODS: This cross-sectional study employed path analysis to investigate the relationships between social determinants of health and MHDs among 725 Iranian adults in Tabriz, Northwest Iran. Data collection occurred between March and September 2022, utilizing a multi-stage and cluster sampling approach. Good governance, social support, perceived discrimination, MHDs, and quality of life were assessed using valid questionnaires. Statistical analysis was conducted using SPSS-24 and Lisrel-8 software, with a significance level set at p < 0.05.
RESULTS: This study found that nearly 70.0% of the participants reported experiencing mental health problems. The path analysis showed that good governance had a significant indirect and negative effect on MHDs via quality of life (β = -0.05; P < 0.05). Major racial discrimination had a positive relationship in the direct and indirect paths (β = 0.24; P < 0.01). While, social support was a directly and indirectly significant predictor of decreased MHDs (β = -0.17, p < 0.01). Furthermore, quality of life had a negative relationship on the indirect path with MHDs (β = -0.24, P < 0.01).
CONCLUSIONS: This study reveals a significant burden of mental health issues among Iranian adults. It highlights the crucial role of social factors like good governance, social support, and perceived discrimination in shaping mental health through their impact on quality of life. Consequently, addressing these factors through improved governance, strengthened social support systems, and active efforts to reduce discrimination is essential for promoting mental well-being.

OBJECTIVE: This study aimed to understand the composition and influencing factors of epilepsy patients\' hospitalization expenses, thus providing a reference for reducing the disease burden of epilepsy patients in low- and middle-income developing countries.
METHODS: A total of 4206 hospitalized cases of epilepsy from 2018 to 2020 were collected. Descriptive statistics were used to understand the patient cost composition, path analysis was used to understand the direct and indirect factors of hospitalization expenses.
RESULTS: From 2018 to 2020, the average hospitalization expenses for epilepsy patients was 4,299.93 RMB yuan, and the average length of stay was 2.47 days. The highest proportion of hospitalization expenses was diagnosis costs (> 50%), followed by comprehensive medical service costs and drug costs. In terms of the total effect coefficient, the major factors affecting the hospitalization expenses were length of stay (0.880), emergency admission(0.463), and the comorbidities and complications(> 0.250). Hospital length of stay, discharge mode(death) and number of hospitalizations(2 times) affect hospitalization expenses through direct effect. Long-term hospitalization (> 30 days), admission routes(emergency), the comorbidities and complications, presence of drug allergy, and age also affect hospitalization expenses through indirect effects.
CONCLUSIONS: Diagnosis costs and length of stay are important factors affecting the medical expenses of epilepsy inpatients. In general, the quality control of the hospital is good, but it still needs to standardize the diagnosis and treatment behavior of medical staff through the clinical path.

OBJECTIVE: Poor sleep quality has been linked to adverse health outcomes. It is important to understand factors contributing to sleep quality. Previous research has suggested increased cognition and education duration have a protective effect on sleep quality in old age. This study aimed to assess the hypothesis that age-11 intelligence quotient and highest achieved education level are associated with subjective sleep quality at age 60.
METHODS: Participants are members of the Newcastle Thousand Families Study birth cohort, all born in 1947. Data included a calculated intelligence quotient score based on participant\'s 11-plus exam results, highest achieved education level, social class at ages 25 and 50 and global Pittsburgh Sleep Quality Index (PSQI) at age 60. Multivariable regression analysis was used to investigate effect sizes of variables on global PSQI, which formed the basis of a path analysis model.
RESULTS: After excluding participants with incomplete data, and those who had been diagnosed with sleep apnea, 251 participants were included in the path analysis model. Education level was associated with global PSQI (R=-0.653; 95% CI -1.161, -0.145; P = .012) but age-11 intelligence quotient was not. While a similar association was seen for women in the stratified analysis, no such associations were seen for men.
CONCLUSIONS: The results of this study show an inverse relationship between education level, but not childhood intelligence quotient, and sleep quality in later life, in women only. Future research is needed to examine the mechanism underlying this relationship.

Marine ecosystems are experiencing growing pressure from multiple threats caused by human activities, with far-reaching consequences for marine food webs. Determining the effects of multiple stressors is complex, in part, as they can affect different aspects of biological organisation (behaviour, individual traits and demographic rates). Determining the combined effects of stressors, through different biological pathways, is key to predict the consequences for the viability of populations threatened by global change. Due to their position in the food chain, top predators such as seabirds are considered more sensitive to environmental changes. Climate change is affecting the prey resources available for seabirds, through bottom-up effects, while organic pollutants can bioaccumulate in food chains with the greatest impacts on top predators. However, knowledge of their combined effects on population dynamics is scarce. Using a path analysis, we quantify the effects of climate change and pollution on the survival of adult great black-backed gulls, both directly and through effects of individuals\' body mass. Warmer ocean temperatures in gulls\' winter foraging areas in the North Sea were correlated with higher survival, potentially explained by shifts in prey availability associated with global climate change. We also found support for indirect negative effects of organochlorines, highly toxic pollutants to seabirds, on survival, which acted, in part, through a negative effect on body mass. The results from this path analysis highlight how, even for such long-lived species where variance in survival tends to be limited, two stressors still have had a marked influence on adult survival and illustrate the potential of path models to improve predictions of population variability under multiple stressors.

Over the past decade, the rapid development of artificial intelligence has propelled the transition of autonomous vehicles from laboratories to real-world applications. However, autonomous vehicles are a long way from fully integrating into most people\'s lives. Previous studies indicate that the word-of-mouth effect is often used by consumers to determine the quality of innovative technologies. Word-of-mouth recommendation can not only increase the income of enterprises by attracting new customers, but also greatly reduce the promotion and publicity expenses of enterprises. Through the word-of-mouth effect, the intention to recommend can contribute to the growth of the autonomous driving market. Therefore, current research explores the mechanisms among the perceived risk of privacy safety, perceived defect, perceived behavioral control, intention to use, and intention to recommend through path analysis. Our findings, based on 433 online questionnaires, indicate that the perceived risk of privacy safety, perceived defects, and perceived behavioral control influence the intention to recommend. Notably, perceived risk of privacy safety and perceived defect directly affects the intention to recommend and also correlates with perceived behavioral control. These findings provide some empirical evidence for the recommendation of autonomous vehicles and the expansion of consumer groups.

BACKGROUND: Mobile health (mHealth) implementation is crucial for developing sustainable healthcare systems, but it faces the challenge of user acceptance. Extending traditional acceptance models allows for the cognitive, emotional and social aspects of engaging with mHealth to be captured, creating a more comprehensive understanding of users\' intentions to use it in the future. User-centred intervention studies based on users\' real experiences with mHealth are essential for accurate assessments and for improving upon studies that rely merely on anticipated mHealth use.
METHODS: An intervention study was conducted with 103 patients with at least one chronic condition (type 2 diabetes and/or arterial hypertension) who had used an mHealth service for three months. They were recruited through purposive sampling at a community health centre in Slovenia. Path analysis was applied to the survey data collected after a three-month testing period to validate an explanatory model with eight hypotheses.
RESULTS: The intensity of mHealth use affected usability, which in turn affected acceptability, the psychosocial impacts of engagement with mHealth and intention for future use. The results showed that the intensity of mHealth use did not affect mHealth acceptability. Likewise, acceptability did not affect the psychosocial impacts of engagement with mHealth or the intention for its future use. Notably, perceptions of the psychosocial impacts of mHealth had no significant effect on the intention for future use.
CONCLUSIONS: Usability and intensity of use play a central role in the post-intervention usage of mHealth, offering valuable insights for policymakers and healthcare providers involved in the delivery of mHealth-based treatment to patients with chronic diseases.

UNASSIGNED: The present study investigates what may influence individuals to experience their religiosity/spirituality as either subjectively positive [religious or spiritual (r/s) wellbeing] or as negative (r/s struggles). Drawing on existing literature attachment insecurity and the seven primary emotions as outlined by Jaak Panksepp in Affective Neuroscience are identified as likely influences.
UNASSIGNED: The final sample consisted of 340 participants (age: M = 36, SD = 14.2; 68.5% = female), among which 65% self-identified as religious/spiritual. A path analysis was conducted to test a proposed mediation model in which the expected effects of primary emotions (B-ANPS) on r/s wellbeing (MI-RSWB) and r/s struggles (RSSS) were mediated through attachment insecurity (ECR-RD8).
UNASSIGNED: The data indicated that attachment insecurity fully mediated the relationships between the primary emotions SADNESS and LUST with r/s struggles. Furthermore, the primary emotions FEAR and ANGER displayed small direct effects on both r/s struggles and r/s wellbeing. Overall, the model, which demonstrated excellent model fit, was able to explain 30% of the variance of r/s struggles, 24% of attachment insecurity and 5% of r/s wellbeing.
UNASSIGNED: The findings suggest that primary emotions such as SADNESS and LUST substantially explain r/s struggles and that these relationships seem to be mediated through attachment. Moreover, r/s struggles seem to be qualitatively distinct from r/s wellbeing. Finally, a moderate link between LUST and attachment suggests that sexuality plays a significant role in (adult) attachment processes.

Herbivory is a major fitness pressure for plants and a key driver of crop losses in agroecosystems. Dense monocultures are expected to favor specialist herbivorous insects, particularly those who primarily consume crop species; yet, levels and types of herbivory are not uniform within regional cropping systems. It is essential to determine which local and regional ecological factors drive variation in herbivory in order to support functional agroecosystems that rely less on chemical inputs. Crops in the genus Cucurbita host a suite of both generalist and specialist herbivores that inflict significant damage, yet little is known about the relative contribution of these herbivores to variation in herbivory and how local- and landscape-scale Cucurbita resource concentrations, management practices, and natural enemies mediate this relationship. In this study, we tested whether three foundational ecological hypotheses influenced Cucurbita herbivory across 20 pumpkin fields in the semi-arid Southern High Plains Region of Texas. We used generalized linear mixed models and confirmatory path analysis to assess whether the Density-dependent Herbivory Hypothesis, Resource Concentration Hypothesis, or the Natural Enemies Hypothesis, could explain variation in Cucurbita herbivory and insect dynamics in the context of conventional agronomic practices. We found that herbivory increased over time, indicating that herbivores were causing sustained damage throughout the growing season. We also found that fields with higher local Cucurbita resources had lower herbivory, suggesting a resource dilution effect. Natural enemy communities were more abundant and taxonomically rich in sites with greater generalist herbivore abundance, though predator abundance declined over time, indicating that late-season crop fields are most at risk given high herbivory and low natural enemy-based control. Our findings also suggest that while local resource availability may drive the abundance and richness of arthropod communities, additional agronomic and phenological information is needed to anticipate herbivory risk in an agriculturally dominated landscape.

Research has pointed to myriad cultural and socio-psychological factors associated with HIV testing, such as acculturation, social norms about HIV testing, masculinity, homonegativity, and constructs from the Theory of Planned Behavior. However, the interrelationships of these factors on the intentions of HIV testing among the population of Asian American men remains unknown. A dataset of 425 Asian American men in the U.S., collected online with convenience sampling method during 2020-2021, was analyzed to test a conceptual framework that aimed to fill this gap. Results from a path model with two endogenous variables (homonegativity and HIV testing intention) indicated that perceived social norms about HIV testing, attitude about HIV testing, and perceived HIV risk had directandindirect relationships with the intentions of HIV testing in the study population. However, social norms about HIV testing and perceived HIV risk showed stronger direct effects (standardized estimates = 0.37 and 0.34, respectively, p-value < 0.001). Additionally, we found that the relationships of these factors with HIV testing intention were also mediated by homonegativity. Findings from this study advance our understanding of pathways of associations between a host of cultural and socio-psychological factors with HIV testing intention among an understudied population - Asian American men. Our results will help inform the development of future intervention programs to increase HIV testing in this population.