Lei Yang

Coffee is one of the most widely consumed beverages worldwide and a major dietary source of bioactive compounds, including caffeine, chlorogenic acids (CGAs), trigonelline, non-digestible polysaccharides, and roasting-derived melanoidins. Habitual coffee consumption has been associated with a lower risk of type 2 diabetes (T2D) and more favorable liver-related outcomes, whereas evidence regarding obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) remains heterogeneous. These associations may reflect interactions among coffee constituents, the gut microbiota, and host metabolic phenotypes rather than the effects of individual compounds alone. In this focused narrative review, we integrate evidence on the gastrointestinal fate, microbial transformation, and systemic availability of major coffee constituents, with particular emphasis on short-chain fatty acids, CGA-derived phenolic acids, and microbiota-dependent bile acid metabolism. We examine how these pathways may influence intestinal barrier integrity, mucosal immunity, enteroendocrine signaling, and gut–liver communication then consider their potential relevance to the regulation of energy, glucose, and lipid metabolism. We evaluate the relevance of these pathways to obesity, T2D, and MASLD, as well as major sources of inter-individual variability, including host genetics, baseline microbiota, metabolic phenotypes, background diet, and coffee composition, processing, brewing, filtration, dose, and beverage additives. Finally, we discuss physiologically relevant exposure levels, candidate biomarkers of individual responses, and risk–benefit considerations. Although mechanistic and preclinical evidence is accumulating, human studies directly demonstrating that coffee-induced microbiota changes mediate beneficial metabolic outcomes remain limited. Future randomized and mechanistic studies should integrate chemically characterized coffee exposures with longitudinal microbiome, metabolomic, physiological, and clinically relevant outcome measurements.

Background: Early childhood caregivers are exposed to intensive caregiving demands and have a high risk of depression. Guided by the family stress process model and Acceptance and Commitment Therapy (ACT), this cross-sectional study examined whether psychological flexibility mediates the association between parenting stress and depression. Methods: A cross-sectional survey was conducted among 1140 Chinese primary caregivers of infants aged 0–36 months in Ya’an, Sichuan, China, from 9 October 2022 to 8 October 2025 using convenience sampling. Validated scales included the Parenting Stress Index-Short Form (PSI-SF), Acceptance and Action Questionnaire-II (AAQ-II) (Higher AAQ-II scores reflected lower psychological flexibility), and Patient Health Questionnaire-8 (PHQ-8). Hayes’ PROCESS Model 4, with 5000 bootstrap resamples, was adopted for the mediation analysis. Results: Parenting stress was positively associated with depressive symptoms (r = 0.335, p < 0.01) (weak-to-moderate effect size). Psychological flexibility exerted a partial mediating effect between the two variables, and the indirect effect accounted for 45% of the total effect. Caregivers with lower household income, lower educational level, and those caring for children aged 0–12 months reported significantly higher depression (all p < 0.05). Conclusions: Parenting stress is an important risk factor for depression, and psychological flexibility plays a significant partial mediating role in this relationship. ACT-based interventions targeting psychological flexibility may hold implications for depression among early childhood caregivers.

Several investigations have delved into the heterogeneity of anxiety symptom trajectories throughout pregnancy. However, the causal relationships between prenatal anxiety, stress, and psychological flexibility remain unclear. This study endeavored to identify distinct trajectory groups and influencing factors for anxiety symptoms in pregnant women, and explore the relationship between stress, psychological flexibility, and anxiety during this period. Pregnant women were recruited from March to May 2022 at a hospital in Xi’an City, Shaanxi Province, China. Structured questionnaire surveys were conducted through a WeChat applet at five time points (12, 20, 26, 32, and 37 weeks), collecting information on basic demographics, stress, psychological flexibility, and anxiety throughout their pregnancies. The latent class growth model was employed to identify potential trajectory groups of prenatal anxiety, logistic regression was utilized to analyze the factors associated with these groups, and a linear mixed model was implemented to investigate the relationship between stress, psychological flexibility, and anxiety. Three distinct anxiety trajectory groups were identified. Unplanned pregnancy (OR = 1.76, 95% CI: 1.08–2.87, P = 0.024) and a history of spontaneous abortion (OR = 1.75, 95% CI: 1.10–2.79, P = 0.018) were significantly associated with a heightened risk of developing an anxiety trajectory group. Higher stress at 12 (β = 0.229, 95% CI: 0.187–0.271), 20 (β = 0.249, 95% CI: 0.211–0.287), 26 (β = 0.255, 95% CI: 0.213–0.296), and 32 weeks(β = 0.278, 95% CI: 0.241–0.315) significantly predicted elevated anxiety in late pregnancy (all P < 0.001). While higher psychological flexibility at the same time points predicted lower anxiety (βs from − 0.074 to − 0.099; all P < 0.001). The trajectories of prenatal anxiety symptoms are dynamic and heterogeneous, with stress and psychological flexibility emerging as significant predictive factors. This study offers critical insights into the characteristics of pregnant women in high-risk trajectory groups, highlighting the potential for early intervention to mitigate worsening symptoms. The study was approved by the Ethical Committee of Health Science Center, Xi’an Jiaotong University in accordance with the Declaration of Helsinki (Registration number: 2022 − 1436, date:2022.7.4).

Background Nurses working in high-stress clinical environments are particularly vulnerable to psychological distress. While perceived stress plays a central role in psychological distress, the mechanisms underlying this association remain unclear. Methods A cross-sectional study was conducted with a sample of 2,951 nurses in China. Psychological distress was measured using the Kessler Psychological Distress Scale, perceived stress using the Chinese Perceived Stress Scale, psychological flexibility using the Comprehensive Assessment of ACT Processes, and insomnia using the Insomnia Severity Index. Descriptive statistics, Pearson correlations, and moderated mediation analyses using Hayes' PROCESS macro were employed for data analysis. Results Moderate to severe psychological distress was observed in 62.2% of nurses. Perceived stress was strongly and positively correlated with psychological distress (r = 0.75, p < .01), whereas psychological flexibility was negatively correlated with both perceived stress (r = -0.72, p < .01) and psychological distress (r = -0.68, p < .01). The results of the mediation analysis showed that psychological flexibility mediated 47.64% of the total effect of perceived stress on psychological distress. Moderation analysis showed that insomnia intensified both the direct effect of perceived stress on psychological distress (β _{non−insomnia} = 0.25, t = 20.92, p < .001; β _insomnia = 0.33, t = 22.68, p < .001) and the indirect effect of psychological flexibility on psychological distress (β _{non−insomnia} = -0.12, t = -10.82, p < .001; β _insomnia = -0.17, t = -11.61, p < .001), with stronger associations observed in the insomnia group compared to the non-insomnia group. Conclusions The findings revealed a high prevalence of psychological distress among nurses. Perceived stress was significantly correlated with psychological distress, and psychological flexibility mediated this association. Furthermore, insomnia moderated the effect of perceived stress on psychological distress and the impact of psychological flexibility on psychological distress. These findings underscored the importance of targeted interventions addressing sleep disturbances and enhancing psychological flexibility to mitigate psychological distress, particularly in high-stress professions such as nursing. Trial registration: The study was approved by the Ethics Committee of the Health Science Center, Xi’an Jiaotong University (No. 2020–1336), and complied with the Declaration of Helsinki.

Objectives To cluster prenatal psychological symptoms into different profiles and investigate prenatal psychological symptoms’ sociodemographic, health-related and pregnancy-related factors. Furthermore, health-related quality of life was compared across prenatal psychological symptom profiles. Design Cross-sectional study. Setting Obstetrics clinics of two university-affiliated, governmental, tertiary hospitals in Xi’an City, Northwestern China. Participants Between June and August 2020, 1020 pregnant women who maintained their health assessment appointments at the two research sites participated in this study. Primary and secondary outcome measures This study’s primary outcome was the creation of latent profiles of prenatal psychological symptoms. These were represented by the coexisting symptoms of three common psychological disorders: depression measured using the eight-item Patient Health Questionnaire, anxiety measured using the Generalised Anxiety Disorder-7 and stress measured using the Pregnancy Stress Rating Scale. Secondary outcomes included potential sociodemographic, health-related and pregnancy-related factors associated with prenatal psychological symptoms, which were measured using a researcher-designed information sheet, and health-related quality of life, measured using the 5-Level EuroQol 5-Dimension questionnaire. Results Prenatal psychological symptoms were classified into three latent profiles using latent profile analysis: low (62.9%), moderate (31.3%) and severe (5.8%). Factors associated with the severity of prenatal psychological symptoms included age, relationship with partner, relationship with mother-in-law, history of gynaecological diseases, history of dysmenorrhoea, stage of pregnancy, unplanned pregnancy, severity of vomiting symptoms and abnormal pregnancy indicators. Moreover, an inverse association was identified between the severity of prenatal psychological symptoms and health-related quality of life. Conclusions Considering the high prevalence of prenatal psychological symptoms and their adverse effects on health-related quality of life, the assessment of prenatal psychological symptoms should be integrated into prenatal healthcare and made routine practice. Investigating the relevant associated factors would be beneficial for identifying vulnerable individuals.

Purpose: We aimed to study the effect of music therapy combined with aerobic exercise on the sleep quality of patients undergoing chemotherapy after a radical mastectomy. Methods: A randomized controlled trial was conducted at the Breast Disease Diagnosis and Treatment Center, Shaanxi Province Tumor Hospital, from July 2017 to June 2019. 110 female breast cancer patients who underwent a radical mastectomy were recruited and randomly allocated into an intervention group or a control group. The intervention group completed music therapy combined with aerobic exercise from the first to the sixth admission to the hospital for chemotherapy, while the control group received only routine nursing care. The sleep quality of these patients was measured using the Pittsburgh Sleep Quality Index (PSQI). A linear mixed model was used to adjust the PSQI of patients after controlling for other confounding factors. Results: The mean sleep quality score of the breast cancer patients who received chemotherapy after a radical mastectomy (baseline) was 8.86 ± 2.34. The intervention group had a significantly lower mean global PSQI score than the control group from the first test to the third test, with an adjusted mean difference of -1.05 (95%CI: -1.86, -0.24; P = 0.01), -2.89 (95%CI: -3.70, -2.08; P < 0.001) and − 4.84 (95%CI: -5.65, -4.03; P < 0.001), respectively. A change in the global PSQI score from baseline for the intervention group was from 0.55 (95%CI: -0.24, 1.34; P = 0.171) at the first test to 2.75 (95%CI: 1.96, 3.53; P < 0.001) at the last test, and for the control group was from − 0.51 (95%CI: -1.31, 0.29; P = 0.213 at the first test to -2.10 (95%CI: -2.91, -1.30; P < 0.001) at the last test. Conclusions: An intervention of music therapy combined with aerobic exercise can significantly improve the sleep quality of female breast cancer patients undergoing chemotherapy after a radical mastectomy, and this intervention continuously improves many aspects of sleep reactivity. Clinical trial registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100042975, 02/02/2021).

Background: This study aimed to reduce the unprecedented and intense psychological distress that nurses were forced to experience during the COVID-19 pandemic. A Chinese version of the World Health Organization's Self-Help Plus (SH+) intervention guide was adapted and tested among nurses. The objective of this study was to translate and adapt the SH+ guideline into the Chinese version and to test its feasibility in reducing psychological distress among nurses during COVID-19.Methods: A staged approach comprising translation, adaptations, initial evaluation by pilot implementation, and a qualitative process evaluation was conducted in two hospitals in Xi'an, China. The translation of the Chinese version was authorized by the World Health Organization. We adapted SH+ for use among clinical nurses working during the pandemic in China through a qualitative process evaluation, which was guided by the descriptive phenomenological study design. The outcomes of the pilot included psychological distress, psychological flexibility, depressive and anxiety symptoms, post-traumatic stress disorder (PTSD) symptoms, and subjective psychological wellbeing, which were assessed using the Kessler 6 symptom checklist, the Comprehensive Assessment of ACT Process (CompACT), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), the PTSD Checklist-Civilian Version (PCL-C), and the Index of Wellbeing (IWB), respectively.Results: The SH+ materials, including audio-recorded sessions and an accompanying illustrated manual, were translated into Chinese and adapted in line with feedback from the nurses. An uncontrolled pilot study (n = 28) for 5 weeks showed a statistically significant reduction of psychological distress (mean difference in Kessler 6 score, −2.74; 95% CI [−3.71, −1.78]; p < 0.001). We also found improvements in psychological flexibility (mean difference in CompACT score, 6.89; 95% CI [−12.35, −4.47]; p < 0.001), subjective psychological wellbeing (mean difference in IWB score, 0.86; 95% CI [0.07, 1.65]; p < 0.05), and depressive symptoms (mean difference in PHQ-9 score, −1.52; 95% CI [−2.78, −0.26]; p < 0.05). The process evaluation showed that nurses found the SH+ program very useful but difficult to adhere to.Conclusion: We found that the translated Chinese version of SH+ was applicable and feasible in the Chinese cultural context. There was a potential effect of adapted SH + in reducing nurses' psychological distress during COVID-19 and suggested the value of exploring strategies to increase adherence to the program.