Again, this could confound findings to the degree that poor dialysis attendance impacted outcomes independent of intermediary effects on IDWG.
Combined with the results of path analysis above among different dimensions, we further prudently inferred that this intermediary effect of occupational burnout could mainly be from the dimension of emotional exhaustion among it.
Overall, we believe the link between MeHg and MI is plausible, given the range of intermediary effects for which some positive evidence exists and the strength and consistency across the epidemiological studies for MI. Figure 1 illustrates this consistency, showing significant overlap between the effect estimates from the four major studies of MI.
There are a host of intermediary effects and influences that complicate that process, including culture, local and socio-historical contexts, the framing and relevance of the issues as well as perceived benefits and risks related to the research, so these should be noted if possible [ 29, 90].
However, some uncertainty remains as to whether a causal relationship exists because of ambiguity in the specific biological mechanism involved, the small number of epidemiological studies, and inconsistencies in the literature supporting some of the intermediary effects (e.g., BP).
However, of the two, we believe that only MI has sufficient evidence to support its inclusion in a benefits assessment, based on both the current evidence linking MeHg to MI directly and the influence of MeHg on intermediary effects leading to MI.
Some of these effects represent clinical outcomes (e.g., hypertension and MI), whereas others are intermediary effects that may contribute to the progression of heart disease [e.g., oxidative stress, atherosclerosis, and decreased heart rate variability (HRV)].
Therefore it cannot be entirely explained by confounding or intermediary effects.
a) Effects of intermediary metabolites and ions on FNLDH (white boxes), PALDH (grey boxes), and ECLDH (black boxes).
To quantify the relation between prenatal famine exposure and adult mortality, taking into account mediating effects of intermediary life conditions.
