Mixed-mode Zentangle and Pastel Nagomi artwork for improving mental well-being in university students during COVID-19 pandemic - a randomized controlled feasibility trial.

Background: University students are identified as a high-risk group for mental health problems. Artworks have been found effective in enhancing individuals' mental well-being in different populations, but none have been conducted on university students. This study was to address this research gap to determine the feasibility and estimate the preliminary effects of Zentangle and Pastel Nagomi on the mental well-being of undergraduate students during the COVID-19 pandemic. Method: This was a 3-arm randomized controlled trial, with 33 undergraduates allocated to two 8-week artworks (Zentangle or Pastel Nagomi Art group) and a control group. Data were collected at baseline, and weeks 4, 6, 8, and 12. Focus group interviews were conducted at the 12-week follow-up. Results: The consent and attrition rates were 80.5 and 6.06%, respectively. The attendance rate ranged from 83.3 to 100%. Compared with the control group, the Pastel Nagomi art group had a significant improvement in retaining positive affect at week 6. This retention could be further observed at week 12. Moreover, the Zentangle group had a significant increase in positive affect at week 4, with better retention at week 12. In addition, the within-group analyses showed that the Pastel Nagomi art group had significantly decreased negative affect at weeks 6 and week 12; and the Zentangle group had significantly decreased depression at week 8. The qualitative findings suggested that the intervention resulted in the participants enjoying the artwork process, and being proud of their artwork and personal growth. Limitation: The study included an imbalance number of online vs. face-to-face sessions, and repeated measures may have affected the results. Conclusion: The study suggests that both artworks are effective in improving undergraduates' mental well-being and that it is feasible to conduct future large-scale studies (263 words).

A cross-sectional survey: Exploring future healthcare workers' intention to use cannabis through extended theory of planned behavior.

Cannabis is the most extensively abused drug, leading to multiple health burdens such as traffic accidents and psychosis. There is a global wave of legalization of recreational and medical cannabis. This study aimed to understand future healthcare workers' intention to use cannabis through extended Theory of Planned Behavior (TPB). An online cross-sectional survey on cannabis, including validated survey tools and questions on demographics, knowledge, and constructs of the TPB was designed, and distributed during virtual classes in late 2020. Responses were obtained from the Faculty of Medicine of a local university. Nine hundred ninety-six responses were collected, of which 629 were complete and analysed. Age was the only demographic variable associated with cannabis use intention (p = 0.029). Respondents with intention had better knowledge of cannabis. All TPB and additional constructs, including perceived behavioral control (COR = 3.44, 95% CI 2.72-4.35, p < 0.001), descriptive norm (COR = 2.24, 95% CI 1.81-2.77, p < 0.001), injunctive norm (COR = 0.51, 95% CI 0.42-0.61, p < 0.001), attitude (COR = 1.23, 95% CI 1.18-1.28, p < 0.001), knowledge (COR = 1.08, 95% CI 1.03-1.14), and perceived availability (COR = 2.75, 95% CI 2.22-3.40, p < 0.001) were individually associated with intention. In the final multiple logistic regression model adjusted for age, only attitude (AOR = 1.19, 95% CI 1.13-1.25, p < 0.001) and perceived availability (p = 0.004) showed statistically significant associations with intention. Descriptive norm (standardized coefficient = 0.570) had better explanatory power than the injunctive norm (standardized coefficient = -0.143) in the model. Perceived behavioral control was associated with intention among respondents with negative to neutral attitudes towards cannabis (AOR = 2.48, 95% CI 1.63-3.77, p < 0.001), but not among those with positive attitudes. All TPB constructs positively correlated with the intention to use cannabis. Changing the attitudes and perceived control on cannabis use may be useful in preventing cannabis use.

L-citrulline enriched fermented milk with Lactobacillus helveticus attenuates dextran sulfate sodium (DSS) induced colitis in mice.

Inflammatory bowel disease (IBD) is a group of chronic inflammatory gastrointestinal diseases that causes worldwide suffering. L. helveticus is a probiotic that can enhance intestinal barrier function via alleviation of excessive inflammatory response. Citrulline, a functional amino acid, has been reported to stimulate muscle synthesis and to function with a prebiotic-like action with certain Lactobacillus strains. The aim of this study was to investigate the potential synergistic effect of combining L. helveticus and citrulline on protection against damage induced by dextran sulfate sodium (DSS) in a mouse model. 6-week-old male C57BL/6J mice were fed with DSS water and randomly divided for administering with different milk treatments: 1) plain milk (control or DSS control), 2) 1% (w/v) citrulline enriched milk (Cit_milk), 3) milk fermented with L. helveticus (LHFM) and 4) DSS+milk fermented with L. helveticus with 1% (w/v) citrulline (Cit_LHFM). The treatment effects on the survival and macroscopic and microscopic signs were examined. All treatments presented different degrees of protective effects on attenuating the damages induced by DSS. All treatments reduced the body weight loss, disease activity index (DAI), histological scores, pro-inflammatory cytokine expression (IL-6, TNF-α and IFN-γ) and production (IL-4) (all P <0.05) and the tight junction (TJ) protein (zonula occluden-1 (ZO-1) expression. LHFM and Cit_LHFM improved survival rate (both at P<0.05). Particularly, Cit_LHFM showed greater effects on protecting the damages induced by DSS, especially in ameliorating colonic permeability, TJ protein (ZO-1, occludin and claudin-1) expression and distribution as well as in reducing IL-4 and IL-17 expression (all P <0.05). Our findings suggested that the combination of and citrulline had significant synergistic effect on protecting against injury from DSS-induced colitis. Therefore, citrulline enriched L. helveticus fermented milk is suggested to be a potential therapy for treating IBD.

The protective effects of enriched citrulline fermented milk with Lactobacillus helveticus on the intestinal epithelium integrity against Escherichia coli infection.

This study examined the protective effects of citrulline enriched-fermented milk with live Lactobacillus helveticus ASCC 511 (LH511) on intestinal epithelial barrier function and inflammatory response in IPEC-J2 cells caused by pathogenic Escherichia coli. Five percent (v/v) of fermented milk with live LH511 and 4 mM citrulline (5%LHFM_Cit-4mM) significantly stimulated the population of IPEC-J2 cells by 36% as determined by MTT assay. Adhesion level of LH511 was significantly increased by 9.2% when incubated with 5%LHFM_Cit-4mM and 5%LHFM_Cit-4mM reduced the adhesion of enterohemorrhagic (EHEC) and entero-invasive (EIEC) E. coli in IPEC-J2 cells by 35.79% and 42.74%, respectively. Treatment with 5%LHFM_Cit-4mM ameliorated lipopolysaccharide (LPS) from E. coli O55:B5 induced activated inflammatory cytokines expression (TNF-α, IL-6 and IL-8) and concentration (IL-6 and IL-8) and early apoptosis. It restored the transepithelial electrical resistance (TEER) and regulated the expression and distribution of tight junction (TJ) proteins (zonula occluden-1 (ZO-1), occludin and claudin-1), toll-like receptors (TLRs) (TLR2 and TLR4) and negative regulators of TLRs signalling pathway (A20 and IRAK-M). In conclusion, our findings suggested that 5%LHFM_Cit-4mM might have the positive effects on improving and maintaining the intestinal epithelial cell integrity and inflammatory response under both normal and pathogenic LPS-stimulated conditions.