Empowering Chinese university health service providers to become mental health champions: insights from the ACE-LYNX intervention.

Background: Evidence shows that there is a high prevalence of mental health challenges including depression and anxiety, among Chinese university students. Providing mental health care providers with professional training is crucial to implementing effective mental health promotion initiatives in university settings. Globally, the focus of the mental health system is shifting to recovery and the importance of empowerment is increasingly being emphasized. There is a call to integrate empowerment education into professional training programs for health service providers with the goal of mobilizing them to become mental health champions capable of advancing mental health care. Method: The ACE-LYNX (Acceptance and Commitment to Empowerment-Linking Youth and Xin i.e., "heart(s)" in Chinese) intervention took place at six universities in Jinan, Shandong Province, China. It aimed to promote mental health literacy and build capacity among mental health service providers (MHSPs) to enable them to become mental health champions at their universities and beyond. A total of 139 university MHSPs participated. We collected pre-, immediate post- and three-month-post-surveys. In addition, we recruited forty-five participants to take part in three-month- post-intervention focus group interviews to explore their experiences taking part in ACE-LYNX and applying the knowledge, skills, and insights they gained from the intervention. Result: This paper reports on the effects of empowerment education, which is a key component of ACE-LYNX, on the MHSPs. Four themes were identified: 1) conscious awareness and behavioral change through psychological empowerment users; 2) professional insights and motivation for organizational empowerment; 3) non-self in the continuum of collective empowerment; and 4) interdisciplinary challenges and divergences in empowerment action. Discussion: We found that it is critical to integrate empowerment education into professional training. The process of MHSPs developing their empowerment practice is characterized by their moving from individual to collective empowerment along a continuum, with organizational and collective empowerment taking place in a longer time frame. Experiential learning, empathy education, and critical reflection accelerated the continuous iterative transformative process of empowerment practices. To advance the integration of empowerment into mental health care, the engagement of organizational decision-makers and policy makers in empowerment training is critical to ensure alignment of empowerment values and competence at all levels of service provision.

Corrigendum: What happened to parents' views of school success for autistic children during the COVID-19 pandemic?

[This corrects the article DOI: 10.3389/fpsyt.2023.1211041.].

Fecal microbiota transplantation for treatment of non-alcoholic fatty liver disease: Mechanism, clinical evidence, and prospect.

The population of non-alcoholic fatty liver disease (NAFLD) patients along with relevant advanced liver disease is projected to continue growing, because currently no medications are approved for treatment. Fecal microbiota transplantation (FMT) is believed a novel and promising therapeutic approach based on the concept of the gut-liver axis in liver disease. There has been an increase in the number of pre-clinical and clinical studies evaluating FMT in NAFLD treatment, however, existing findings diverge on its effects. Herein, we briefly summarized the mechanism of FMT for NAFLD treatment, reviewed randomized controlled trials for evaluating its efficacy in NAFLD, and proposed the prospect of future trials on FMT.

Western life courses challenged in life stories collected in contemporary China.

Introduction: The life course describes the progression of life as a social role, from birth to death. Traditional Western life-history studies of the life course usually describe a continuous lifeline with occasional interruptions in between. The extraordinary temporal events of the Anti-Japanese War (AJW), Civil War (CW), Great Famine (GF), Cultural Revolution (CR), and the Reform and Opening-up of China in just few decades mean that the life history of contemporary Chinese older adults may be quite different from those of their western peers. Methods: The study used qualitative research methods to conduct in-depth interviews with 16 older adults and collect their life stories through a standardized list of questions. Grounded theory was employed to condense, compare, conceptualize, and synthesize patterns within the collected data, approaching the investigation with a "naturalistic" perspective. Results: Based on a generalized analysis of the Interview transcripts, we can find that Chinese old adults' life stories were shaped by recurring exceptional and rapidly changing environmental conditions. The themes and sub-themes of Chinese old adults' life stories were focus on (1) violence, loss of family member, escape and unstable life in their early life which are related to AJW and CW; (2) poverty and starvation in daily life when they were adolescents and young adults which are related to GF; (3) discontinuity, timed opportunities, categorizations in order to split the social relationships and networks in CR. The data also suggest that education is an important part of the life story and that its value changes over time. Discussion: The discontinuity and instability of the life stories of the Chinese old adults are unexpected according to the dominant Western-influenced life course theories, which enriches life course theory and provides a new perspective for studying the individual life course in a society of constant and rapid change.

What happened to parents' views of school success for autistic children during the COVID-19 pandemic?

Background: The educational views of parents with autistic children directly impacts their children's academic success. However, little research has been done on how the COVID-19 pandemic impacted parents' academic and social views. Aim: This study analyzes parents' views of school success for their autistic children in the context of the COVID-19 pandemic and examines the relationships among pandemic stress, parental involvement, and parents' views of school success for autistic children in mainland China. Methods: In this study, 713 parents of autistic children completed measures assessing their pandemic stress, parental involvement, and views of school success; linear regression and structural equation modeling were used to analyze the data. Results: Parents' views of school success were influenced by factors such as parents' level of education, household income, parents' gender, and children's age. The effects of pandemic stress on views of school success for parents of autistic children are complex: physical and mental reaction has a negative direct effect on views of school success, a positive indirect effect mediated by parental involvement, and a net positive effect; risk perception and concern has a negative indirect effect; and both the direct and indirect effects of pragmatic hopefulness are positive. Education policymakers and practitioners need to seriously and carefully assess these results' implications for modern, inclusive education.

Exploring the Dynamics between Specialization and De-Specialization of Welfare Experiences: A Qualitative Study of the Special Families under the One-Child Policy in China.

The one-child policy, i.e., of having only one child per couple, was adopted as the essential family policy in China from 1979, and since the beginning of the 21st century, it has given rise to problems of special families under the one-child policy caused by the death or disability of only children. The existing research focused on the issue of special families from a macro-social level and analyzed the welfare demands and welfare policies of those families, whereas less research has been concerned with the families' individual experiences and interpretations. This study adopted a qualitative research method and conducted in-depth interviews with 33 participants to analyze the welfare experiences of special families in Jinan city, Shandong Province. The findings of the study were based on generalized analyses of the interviews, including the "specialization" dimension of welfare experiences with identity-oriented, targeted, and comprehensive characteristics, the "de-specialization" dimension of welfare experiences with identity-denied, excluded, and hidden characteristics. The dynamics between the two dimensions among different special families, different family members, and different periods in the families' lives were also examined. We present a discussion of the study's findings and their implications, categorized into the theoretical and practical domains.

Psychological Stress and Perceived School Success During COVID-19 Among Parents of Children Who Are Deaf or Hard of Hearing.

This study mainly explored psychological stress due to coronavirus disease 2019 (COVID-19) among parents of deaf and hard-of-hearing children and how it related to parents' views of school success in mainland China. The Psychological Stress Questionnaire and Views of Social and Academic Success were administered to 213 parents of deaf and hard-of-hearing children. Results showed that parents' and children's characteristics were related to psychological stress due to COVID-19, which significantly negatively predicted parents' views of school success. The contributions, limitations, and implications of the present research are discussed.

Parents' pandemic stress, parental involvement, and family quality of life for children with autism.

Background: Research has shown that parents of children with autism spectrum disorder (ASD) suffered high levels of stress during the COVID-19 pandemic and faced poor family quality of life (FQOL). However, little is known about the inherent dynamic interaction between pandemic stress and FQOL, especially in the Chinese cultural context. Aims: This study provides preliminary evidence by examining the relationships among pandemic stress, parental involvement, and FQOL for children with autism in mainland China. Method: A total of 709 parents of children with autism completed measures of FQOL, parental involvement, and pandemic stress. Structural equation modeling was employed to examine the interrelations among these variables. Results: Pandemic stress has direct effect and indirect effect mediated by parental involvement on FQOL. Two dimensions of pandemic stress had a direct effect on FQOL (ß1 = 0.11; ß2 = -0.55) and three dimensions had an indirect effect on FQOL through parental involvement (ß1 = -0.097; ß2 = 0.257; ß3 = 0.114). Conclusion: Stress related to the COVID-19 pandemic affects family quality of life for children with autism in complex ways. Policies may be developed to enhance parental pragmatic hopefulness in the anti-epidemic victory and alleviate negative physical and mental reactions caused by the pandemic.

Chinese University Students' Perspectives on Help-Seeking and Mental Health Counseling.

Psychological distress and mental illness have become increasingly pervasive among Chinese university students. However, many university students who need mental health treatment or psychological support do not actively seek help from professional counselors or service providers, which could lead to poor mental health outcomes. To promote help-seeking, we undertook a qualitative study to understand Chinese university students' perspectives on help-seeking and mental health counseling. We conducted 13 focus group interviews with students in six universities in Jinan, China, and altogether 91 (62%) female students, and 56 (38%) male students participated in the study. Our results indicate that students' misconception and distrust of on-campus counseling, stigma of mental illness, low mental health literacy, and hard-to-access mental health services are the major barriers that impede students help-seeking behaviors. Internal struggles and systematic and organizational barriers are identified to shed light on future work to promote mental health literacy among Chinese university students.

More than Mental Illness: Experiences of Associating with Stigma of Mental Illness for Chinese College Students.

From existing empirical research, we identified that Chinese college students commonly experience stigma surrounding mental illness and found some factors that support them in resisting the stigma and achieving psychological health. However, less research provides qualitative data involving individual experiences and insights on mental illness within this group of college students. This study, based on Linking Hearts (an internationally cooperative research-sharing project between China and Canada), was conducted in Shandong, Jinan, and aims to promote the mental health of college students by empowering interdisciplinary professionals and students. Through the research project, this study analyzed the materials from 24 focus groups, explored the understanding of mental illness and prevalence of mental illness stigma in Chinese colleges at the present time, administered a background questionnaire, and provided statistical support for some revealed themes. The final themes are as follows: mental illness is stereotyped as "severe, pathetic, and complicated"; the misconception of "visiting a psychological counselor is scary"; from public stigma to self-stigma; barriers deterring students from seeking help or accessing services; two sides of the same coin: peer support versus peer pressure.

Mental Health Promotion and Stigma Reduction Among University Students Using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) Framework: Protocol for a Mixed Methods Study.

BACKGROUND: Rapid urbanization, academic pressures, and developmental life transition stressors contribute to mental health stress for postsecondary students in China. Effective prevention, early identification, and timely intervention are challenged by stigma, a lack of mental health literacy, and inadequate mental health resources. OBJECTIVE: Our implementation science (IS) research project is aimed at evaluating the use of an evidence-informed mental health promotion intervention named Acceptance and Commitment to Empowerment - Linking Youth and 'Xin' (hearts) (ACE-LYNX) to promote university student mental health in Jinan, China. METHODS: We will engage and collaborate with Shandong Mental Health Center, the provincial mental health center, and six local universities in different regions of Jinan. The ACE-LYNX intervention aims to reduce social stigma against mental illness, enhance mental health literacy, and improve access to quality mental health care by increasing interdisciplinary collaboration and forming a mental health network. It is based on two evidence-based approaches, Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP), and it will be delivered through online learning and in-person group training. The project will train 90 interdisciplinary professionals using the model. They will in turn train 15 professionals and 20 students at each university. The project will adopt the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework, which provides a structure to examine the process and outcomes of implementation using mixed methods comprising quantitative and qualitative approaches along five dimensions: reach, efficacy, adoption, implementation, and maintenance. RESULTS: Over the course of the project, 720 champions will be directly trained. They will contribute to developing a formal and informal mental health network, strengthened by student-led mental health initiatives and professional-led initiatives to promote collaborative care and facilitated care pathways. We anticipate that our project will reach out to 11,000 to 18,000 students. CONCLUSIONS: This IS protocol will outline our unique intervention model and key steps to contextualize, implement, and evaluate community-based mental health intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/25592.

Efficacy and safety of Kanglaite injection combined with chemotherapy for women breast cancer: A protocol for systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Breast cancer was the second cause of cancer death and approximately accounted for 30% of all newly diagnosed cancer in American women. Adjuvant chemotherapy is the preferred treatment approach for breast patients. Kanglaite injection (KI) was commonly used as adjuvant chemotherapy combined with chemotherapy for women breast cancer which could increase chemotherapy efficacy and alleviate chemotherapy drugs induced adverse events, however, the efficacy and safety for KI combined western medicine remains controversial. Thus, we conducted this protocol of systematic review and meta-analysis to estimate the efficacy and safety of KI combined with western medicine for women breast cancer. METHODS: This study will search electronic database included English medicals databases and Chinese databased up to May 2021. The main outcomes of this study include clinical efficacy rate. Adverse reaction rate, Karnofsky Performance Status and immune function were defined as the secondary outcomes. RESULTS: This protocol study will comprehensively evaluate the efficacy and safety of KI combined with chemotherapy for women breast cancer. CONCLUSION: This protocol for systematic review and meta-analysis will evaluate the efficacy and safety of KI combined with chemotherapy for women breast cancer, aiming to provide optimal therapy for women breast cancer patients.

Promoting the Mental Health of University Students in China: Protocol for Contextual Assessment to Inform Intervention Design and Adaptation.

BACKGROUND: Chinese students are extremely vulnerable to developing mental illness. The stigma associated with mental illness presents a barrier to seeking help for their mental health. OBJECTIVE: The Linking Hearts-Linking Youth and 'Xin' (hearts) project is an implementation science project that seeks to reduce mental illness stigma and promote the mental health of university students in Jinan, China. The Linking Hearts project consists of 3 components. In this paper, we outline the protocol for the first component, that is, the contextual assessment and analysis of the mental health needs of university students as the first step to inform the adaptation of an evidence-based intervention to be implemented in Jinan, China. METHODS: Six local universities will participate in the Linking Hearts project. A total of 100 students from each university (n=600) will engage in the contextual assessment through self-report surveys on depression, anxiety, stress, mental health knowledge, and mental health stigma. Quantitative data will be analyzed using several descriptive and inferential analyses via SPSS. A small number of participants (144 students and 144 service providers) will also be engaged in focus groups to assess the socio-environmental contexts of university students' health and availability of mental health resources. Qualitative data will be transcribed verbatim and NVivo will be used for data management. Social network analysis will also be performed using EgoNet. RESULTS: Linking Hearts was funded in January 2018 for 5 years. The protocol of Linking Hearts and its 3 components was approved by the research ethics boards of all participating institutions in China in November 2018. Canadian institutions that gave approval were Ryerson University (REB2018-455) in January 2019, University of Alberta (Pro00089364), York University (e2019-162) in May 2019, and University of Toronto (RIS37724) in August 2019. Data collection took place upon ethics approval and was completed in January 2020. A total of 600 students were surveyed. An additional 147 students and 138 service providers took part in focus groups. Data analysis is ongoing. Results will be published in 2021. CONCLUSIONS: Findings from this contextual assessment and analysis will generate new knowledge on university students' mental health status, mental health knowledge, and resources available for them. These findings will be used to adapt and refine the Acceptance and Commitment to Empowerment-Linking Youth N' Xin intervention model. The results of this contextual assessment will be used to inform the adaptation and refinement of the mental health intervention to promote the mental health of Chinese university students in Jinan. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/25009.

Association between Mental Health Knowledge Level and Depressive Symptoms among Chinese College Students.

This study aimed to explore the association between mental health knowledge level and the prevalence of depressive symptoms among Chinese college students. A cross-sectional study was conducted in six universities in Jinan, Shandong Province, China, and a total of 600 college students were recruited to self-complete a series of questionnaires. The Mental Health Knowledge Questionnaire (MHKQ) was used to investigate the level of mental health knowledge. Depressive symptoms were investigated with the depression subscale of the Depression Anxiety Stress Scale (DASS-21). The prevalence rate of depressive symptoms among college students was 31.2%. Compared with MHKQ scoring in the 1st quartile, college students with MHKQ scoring in the 3rd quartile and in the 4th quartile reported lower levels of depressive symptoms after adjusting for potential confounding factors. Since mental health knowledge level was related to depressive symptoms among college students, increased efforts to promote the level of mental health knowledge in Chinese college students are critical.

Promoting and Tuning Porosity of Flexible Ether-Linked Phthalazinone-Based Covalent Triazine Frameworks Utilizing Substitution Effect for Effective CO2 Capture.

Five porous ether-linked phthalazinone-based covalent triazine frameworks (PHCTFs) were successfully constructed via ionothermal polymerizations from flexible dicyano monomers containing asymmetric, twisted, and N-heterocyclic phthalazinone structure. All the building blocks could be easily prepared by simple and low-cost aromatic nucleophilic substitution reactions, showing the large-scale application potential of thermal stable phthalazinone structure in constructing porous materials. Generally, the flexible building blocks are avoided to prevent the networks from collapsing in constructing high surface area porous materials. Our experimental results revealed that the introduction of the substituents can effectively decrease the probability of the network interpenetration from the longer struts and the intermolecular/intramolecular intercalation from the increased degree of conformation freedom in the flexible ether-linkage, the BET surface areas of PHCTFs increasing from 676 to 1270 m2 g-1. Meanwhile, the effects of introducing different sizes (methyl or phenyl group) and amounts (one or two) of substituents on the porosities of the target polymer networks were also investigated in detail. The high CO2 adsorption capacity of 10.3 wt % (273 K, 1 bar) can be ascribed to the strong affinity of the electron-rich N,O-containing networks with CO2. Excitingly, PHCTF-5 demonstrates the high CO2/N2 selectivity up to 138 (273 K, 1 bar), according to the ideal adsorbed solution theory (IAST) for the higher proportion of Vmicro accompanied the electron-rich heteroatoms characteristic. Such high CO2 adsorption capacity and good separation properties are superior to those of many other microporous organic polymers. These properties along with easily up-scalable synthesis make porous PHCTFs promising candidates applied in gas sorption and separation field.