Depression and diabetes frequently co-occur, and chronic low-grade systemic inflammation has been proposed as one of many potential factors that may account for the association between these two conditions. This study aimed to empirically examine systemic inflammation as a potential mediator of the association between depression and prevalent diabetes. This study analyzed 2015-2018 NHANES data (N = 7,583) using a counterfactual causal mediation approach. Depression was assessed via the Patient Health Questionnaire, systemic inflammation via high-sensitivity C-reactive protein, neutrophils-to-lymphocytes ratio, and platelet-to-lymphocytes ratio, and diabetes via HbA1c or self-report. Mediation effects were decomposed into natural direct effect (NDE), natural indirect effect (NIE), and total effect. Percentile bootstrapping with 1000 resampling was used to generate confidence intervals (CI). Depression was associated with 62% greater odds of prevalent diabetes (total effect: OR = 1.62, 95% CI: 1.20 - 2.24). There was a significant positive natural direct effect regarding the association between depression and prevalent diabetes (NDE: OR = 1.60, 95% CI: 1.18 - 2.19), and a positive but small natural indirect effect through systemic inflammation (NIE: OR = 1.02, 95% CI: 1.01 - 1.04). Similar findings were observed in the multiple imputed datasets. Depression is associated with greater odds of prevalent diabetes, with systemic inflammation contributing to a small but significant proportion of the observed association. Further research should assess other potential physiological or behavioral mediators that may account for the association between depression and prevalent diabetes.
Samuel Akyirem, J. Okyere, Jonathan Bayuo et al.· Biological Research for Nurs...· 0 citations
Digital infrastructures such as platforms, algorithms, and artificial intelligence (AI) are rapidly reshaping the conditions under which nursing care is enacted, raising ethical concerns that extend beyond efficiency. Indeed, as nursing becomes increasingly embedded within platformized and AI-mediated ecosystems, the discipline is confronted with new forms of harm arising from the disruptions to the relational foundations that make ethical nursing possible. Despite this, the discipline lacks a coherent conceptual framework capable of naming, analysing, and responding to the relational injuries produced by digital infrastructures and platformization. This paper introduces the concept of digital-relational harm. Drawing on six philosophical and theoretical traditions: African relational ontology, Western phenomenology and care ethics, Eastern relational philosophies, relational ethics, Labour Process Theory, and digital professionalism, the paper demonstrates that digital-relational harm arises when digital infrastructures disrupt person becoming, displace embodied and intersubjective presence, disturb relational harmony, erode trust and mutuality, fragment labour and continuity, and destabilise professional identity. These disruptions are structural, relational, and ontological. By naming digital-relational harm, the paper reframes digital transformation as an ethical and relational challenge, not merely a technical one, and argues that safeguarding relational integrity must become a central concern in the design, governance, and evaluation of digital health systems. Digital-relational harm offers nursing ethics a new analytic lens for understanding how digital environments shape moral life and provides a foundation for future empirical, theoretical, and policy-oriented work.