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BACKGROUND: The integration of concept mapping into nursing education represents a pivotal strategy aimed at enhancing critical thinking skills, which is a necessity in navigating the complexities of healthcare. This educational tool's role in stimulating students' analytical abilities and motivation towards critical thinking has become increasingly relevant in preparing nursing professionals for the dynamic challenges of their field. OBJECTIVES: The aim of this study is to examine how the implementation of concept mapping affects critical thinking motivation among nursing students, investigate the relationship between them, and support its use as an innovative educational strategy in the field of nursing. DESIGN: This study was conducted using a descriptive and exploratory design. METHODS: This research was carried out between May and June 2023, involving 435 nursing students. For data collection within an online classroom framework, the study applied a trio of tools: the Student Descriptive Information Form, the Scale for the Effectiveness of Concept Maps in Nursing Education, and the Critical Thinking Motivation Scale. The analysis of the compiled data was undertaken utilizing SPSS version 25.0 and JAMOVI software, with statistical significance set at a p-value of <0.05. RESULTS: Engagement in social/scientific activities, library usage, and book reading habits were positively correlated with higher scores on both the Critical Thinking Motivation Scale and the Scale for the Effectiveness of Concept Maps in Nursing Education. Notably, concept mapping significantly enhanced critical thinking motivation among the participating students, as evidenced by the path analysis (ß = 0.758, R = 0.563, p < 0.001). CONCLUSION: The findings underscore the significant role of concept mapping in elevating critical thinking motivation among nursing students, suggesting its strategic inclusion in nursing curricula to meet the evolving demands of healthcare education in the twenty-first century.

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Background: Prenatal anxiety and depression exert a significant influence on the physiological and psychological health outcomes of both expectant mothers and their infants. The aim of this study was to explore the intrinsic relationships between maternal anxiety, depression in early pregnancy, and their influencing factors. The findings of this study provide scientific basis for developing targeted preventive interventions. Methods: The study involved 887 expectant mothers in the early stages of pregnancy residing in Changsha City from March to August 2022. The sociodemographic characteristics, health and lifestyle factors, and pregnancy-related factors of participants were collected. The Edinburgh Postnatal Depression Scale and the Self-Rating Anxiety Scale were used to assess depression and anxiety, respectively. Chi-square tests and multivariate logistic regression models using SPSS 26.0 were used to assess factors impacting early pregnancy anxiety and depression. Amos 23.0 was used to construct a path model to determine the potential pathways of the influencing factors. Results: In early pregnancy, the prevalence of depression and anxiety were 17.4% and 15.8%, respectively. Path analysis showed that early pregnancy anxiety and illness during pregnancy had a direct effect on early pregnancy depression. Anxiety had the greatest overall impact on early pregnancy depression. Education, maternal comorbidities, symptoms of pregnancy, electronic device usage time, work stress, active smoking in the 6 months before pregnancy, and sleep quality were found to solely exert indirect effects on early pregnancy depression. Sleep quality had the greatest overall impact on early pregnancy anxiety. Active smoking in the 6 months before pregnancy, sleep quality, and work stress only had a direct impact on early pregnancy anxiety. Additionally, electronic device usage duration and monthly per capita household income exclusively indirectly impacted symptoms of early pregnancy anxiety. Conclusion: The study highlights the importance of targeted interventions in early screening. Avoiding excessive use of electronic devices and active smoking in the 6 months before pregnancy, alleviating work stress and symptoms of pregnancy, increasing education levels and monthly per capita household income, improving sleep quality, and actively preventing illnesses during pregnancy and maternal comorbidities might reduce anxiety and depression in early pregnancy.

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The present study explored the associations between orthorexia nervosa, social media addiction, emotion regulation difficulties, perfectionism and BMI with four facets of mindful eating, using path analysis to assess these relationships. A sample of 551 students (127 males, 424 females, mean age = 22.6 years) completed an online self-report questionnaire evaluating these constructs. Analyses revealed that mindful eating contributed to emotion dysregulation and orthorexia nervosa and was related to social media addiction. Significant indirect paths were identified from mindful eating, social media addiction and adaptive perfectionism through emotion dysregulation to maladaptive perfectionism. While no direct paths were observed between mindful eating and perfectionism, a direct path was found between adaptive perfectionism and orthorexia nervosa. These findings suggest a more nuanced understanding of eating behaviours is required. Individuals susceptible to eating disorders should approach mindful eating with caution and seek support from healthcare providers to ensure it is used in a way that supports overall wellbeing. Future research should aim to replicate and further clarify these associations to reveal the long-term effects of mindful eating.

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Investigating among-individual differences in reproductive success and survival is essential for understanding eco-evolutionary processes. We used 5 years of demographic data from 556 breeding barn owls (Tyto alba) to estimate associations between intrinsic and extrinsic covariates on survival and reproduction throughout the annual cycle. As males and females have distinct roles in reproduction, environmental conditions and individual quality may be differentially linked to their fitness at different time points. Males breeding early and inhabiting prey-rich areas experienced higher reproductive success but faced greater reproductive costs. Indeed, the number of offspring a male cared for was negatively associated with his body condition and survival. However, our results indicate that these influences can be mitigated in males experiencing favourable post-breeding environmental conditions. For female owls, early breeding and high food availability during the breeding period were linked with increased reproductive success. Prey availability during incubation and higher reproductive output were associated with higher survival into the next breeding period in females. Unlike males, females did not exhibit obvious trade-offs between reproductive success and survival. Our research demonstrates trade-offs between fecundity and survival, and that females paired with males able to provide sufficient food experience higher survival and reproduction.

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To investigate the effects of different typical exogenous salt concentrations on total soil salinity and the growth of Lycium barbarum under brackish water irrigation, and to determine the salinity threshold of irrigated brackish water that is conducive to the normal growth of Lycium barbarum while mitigating soil salinity accumulation. Four typical exogenous salts (NaCl, CaCl2, NaHCO3, Na2SO4) were selected and set at four concentrations (0.1, 0.5, 2.0, 4.0 g L-1) to conduct a field crossover experiments in the downstream region of the Hetao Irrigation District. The results showed that in the same fertility period, the growth rates of new branches, ground diameter, and crown width first increased and then decreased with rising concentrations of NaCl, CaCl2, and Na2SO4, but showed an inverse relationship with NaHCO3 concentrations. Furthermore, increasing salt concentrations linearly reduced the yield of dry fruits from Lycium barbarum and led to a notable accumulation of total soil salts. Utilizing an experimental research approach, a comprehensive analysis of involving multiple growth indices, stable yield, and soil salinity control of Lycium barbarum revealed that optimal growth occurs at salt concentrations of 0.1-0.5 g L-1 for different water quality areas within the irrigation area; using the method of path analysis identified the total soil salt and crown width as the primary direct and indirect factors influencing the yield of Lycium barbarum. The results of this study provide scientific basis and significant theoretical support for the safe and rational utilization of brackish water and cultivation of Lycium barbarum in typical regions with varying saline water qualities of Hetao irrigation area.

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OBJECTIVES: The present study aims to examine the hypothetical model of the relationship between food insecurity and Non-alcoholic fatty liver disease (NAFLD) in a sample of Iranian adults. METHODS: In this cross-sectional study, 275 subjects (18-70 years old) who met the inclusion criteria were recruited. Fatty liver was diagnosed by abdominal ultrasonography, and eligible patients underwent liver fibro scan assessment to determine fibrosis and steatosis. Food insecurity was assessed using the validated six-item Short Questionnaire of Household Food Security Scale (SQHFSS). Data were analyzed using SPSS 24.0 and IBM SPSS Amos 24.0. RESULTS: Among 275 subjects (44.37 ± 11.67 years old, 51.6% male) included in the analysis, 23.6% were food insecure. Food insecurity, general and abdominal obesity were associated with an increased risk of NAFLD, even after multiple adjustments (OR: 2.95, 95% CI: 1.02, 8.57; OR: 3.27, 95% CI: 1.50, 7.11; and OR: 3.81, 95% CI: 1.55, 9.32, respectively). According to the primary hypothesis, food insecurity and NAFLD were fitted into a model (χ2/df = 1.36, GFI = 0.982, AGFI = 0.952, CFI = 0.954, IFI = 0.959, SRMR = 0.040, RMSEA = 0.037); accordingly, food insecurity and obesity (general and abdominal) directly affected NAFLD (ß = 0.12, P = 0.03; ß = 0.13, P = 0.02; ß = 0.31, P < 0.001, respectively). CONCLUSION: Food insecurity was a predictor of, and directly associated with, NAFLD. Social determinants should be considered in the pathogenesis of NAFLD, although the possible underlying biological mechanisms in this association are yet to be determined.

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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.

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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.

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Why does a beneficial treatment effect on a longitudinal biomarker not translate into overall treatment benefit on survival, when the biomarker is in fact a prognostic factor of survival? In a recent exploratory data analysis in oncology, we were faced with this seemingly paradoxical result. To address this problem, we applied a theoretically principled methodology called dynamic path analysis, which allows us to perform mediation analysis with a longitudinal mediator and survival outcome. The aim of the analysis is to decompose the total treatment effect into a direct treatment effect and an indirect treatment effect mediated through a carefully constructed mediation path. The dynamic nature of the underlying methodology enables us to describe how these effects evolve over time, which can add to the mechanistic understanding of the underlying processes. In this paper, we present a detailed description of the dynamic path analysis framework and illustrate its application to survival mediation analysis using simulated and real data. The use case analysis provides clarity on the specific exploratory question of interest while the methodology generalizes to a wide range of applications in drug development where time-to-event is the primary clinical outcome of interest.

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OBJECTIVES: 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.

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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 (ß = -0.05; P < 0.05). Major racial discrimination had a positive relationship in the direct and indirect paths (ß = 0.24; P < 0.01). While, social support was a directly and indirectly significant predictor of decreased MHDs (ß = -0.17, p < 0.01). Furthermore, quality of life had a negative relationship on the indirect path with MHDs (ß = -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.

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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. CONCLUSION: 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.

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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.

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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. CONCLUSION: 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.

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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.

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Purpose: This study for the first time delves into the intricate relationship between scientific literacy and the acceptance of traditional Chinese medicine (TCM) by employing a multigroup path analysis based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. We adopted Scientific Epistemology Belief (SEB) as an indicator for measuring scientific literacy due to its comprehensive reflection of individuals' understanding of scientific knowledge and knowing. In assessing TCM acceptance, we focused on Chinese parents' receptivity towards pediatric TCM, as it offers a more genuine representation of actual inclinations. Methods: A convenience sample of 1016 Chinese parents in Southern China was assessed using online Likert-scale questionnaires on SEB and UTAUT determinants (including performance expectancy, social influence, risk awareness, and facilitating conditions). A K-means cluster analysis was employed to discern distinct SEB profiles, followed by a multigroup path analysis to ascertain UTAUT model variations across these profiles. Results: Five SEB profiles were identified, namely, intermediate, absolutistic, multiplistic, sophisticated, and evidence-based. Evidence-based believers manifested the highest pediatric TCM acceptance, albeit with elements of blind faith, while multiplistic skeptics, prone to questioning everything, displayed the least acceptance. The absolutistic, intermediate, and sophisticated demonstrated moderate TCM acceptance levels, with the intermediate profile outscoring both absolutistic and sophisticated. These findings highlight that individuals with high scientific literacy do not blindly endorse TCM, nor do those with limited scientific understanding fully appreciate TCM's merits. Conclusion: SEB significantly moderates TCM acceptance factors in the UTAUT model, indicating that extremes in scientific knowledge spectrum result in less balanced TCM perspectives. Our findings pave the way for novel insights into harmonizing modern and traditional medical practices.

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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.

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Objective: 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. Methods: 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). Results: 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. Conclusions: 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.

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Placeness is believed to play a significant role in enhancing the well-being and place-use of individuals, contributing profoundly to how spaces are experienced and interacted with. Despite its perceived importance, there is ongoing debate and insufficient clarity about how exactly placeness influences people's behavior. This study aims to bridge this gap by theorizing and investigating the pathways from placeness to people's behavioral intentions, emphasizing the roles of personal place attachment and public place image as pivotal mediators in this relationship. To explore these dynamics, we conducted a survey in Japan, examining the complex interplay between placeness and behavioral intentions, given their rich cultural heritage and modern urban pressures. We employed the Partial Least Squares Structural Equation Modeling (PLS-SEM) approach for path analysis. The analysis suggests that placeness influences behavioral intention through personal place attachment. While placeness does affect public place image, this public image does not have an impact on behavioral intention. The results demonstrated that an individual's activities, experiences, and cognition of a place are significant factors in creating the intention to engage in word-of-mouth, recommendation, and revisiting behaviors. Policymakers, urban planners, and designers need to understand how to foster people's behavioral intentions when creating a place imbued with placeness.

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BACKGROUND: There is a lack of consensus about the operationalization of vitality, which is one of the intrinsic capacity (IC) domains. In particular, no study has investigated whether cardiorespiratory fitness (CRF) can be considered a vitality indicator. OBJECTIVE: To examine whether vitality is the upstream domain of IC, and establish the validity of CRF as a vitality indicator, using maximal oxygen consumption (VO2 max) as a representative. METHODS: 561 older adults from a longitudinal cohort study were included. Variables under consideration were VO2 max, other IC domains, instrumental activities of daily living (IADL), and handgrip strength, which was considered an already validated indicator of vitality. Using handgrip strength as the reference point, path analyses were performed to examine whether VO2 max followed a similar hierarchical structure in predicting change in IADL difficulty through other IC domains. RESULTS: The mean age of the participants was 75.5 years. The path model in which vitality was measured by VO2 max demonstrated adequate fit, which was similar to the model in which vitality was measured by handgrip strength. Regarding the path coefficients, the model using VO2 max demonstrated significant total and indirect effects. Notably, the indirect effect was due to the locomotor domain (standardized coefficient = -0.148, p < .001), but not the cognitive or psychological domain. CONCLUSION: Vitality is the upstream domain of IC. VO2 max can be considered an indicator to operationalize the vitality concept.

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