Chinese herbal medicine for insomnia : evidence and experience

Insomnia, a condition with significant medical consequences, is becoming more and more prevalent worldwide. Hypnotic drugs are associated with dependence, adverse reactions and long-term risks. Psychotherapy is time- and resource-consuming and largely unavailable. As such, many people who present with insomnia also look for alternative treatments. Recent studies show that Chinese herbal medicine (CHM), a traditional herbal medicine based on holistic theories, could be a potential alternative. The aims of this doctoral research were to explore the potential benefits of CHM for the treatment of insomnia and provide guidance in the treatment of insomnia with CHM. For practical reasons, the empirical aspect of the investigation focuses on one specific CHM product, which is Zao Ren An Shen (ZRAS). The research questions include: (1) Is ZRAS a safe and effective treatment for insomnia disorder? (2) How do Chinese medicine clinicians diagnose and treat insomnia with CHM? This doctoral research consists of a narrative review and three major studies: one systematic review, one randomised, placebo-controlled trial and one clinical experience synthesis. In the systematic review, clinical trial that assessed the efficacy and/or safety of ZRAS for insomnia were systematically searched and screened. In the clinical trial, after one week of placebo run-in, 85 participants with insomnia disorder were randomly allocated to either take ZRAS capsule or placebo for four weeks. Insomnia severity, psychological status, fatigue levels, quality of life, subjective sleep parameters, objective sleep parameters, and adverse events were assessed through the intervention period and at a four-weeks follow-up. Both the investigator and the participants were blind to the treatment allocation. In the clinical experience synthesis (CES), clinical experience reports published in the literature, which described treatment of insomnia with CHM, were systematically reviewed and screened. The systematic review shows that ZRAS is safe and effective for insomnia. The randomised trial support ZRAS capsule as a safe and acceptable treatment, yet failed to improve significantly insomnia severity in insomnia patients. These differences may be explained by the poor quality of the studies included in the systematic review. The studies included in the systematic review and the randomised trial both used a standardised intervention approach. However, Chinese medicine clinician recommend an individualised approach, which may contribute to improved outcomes across a broader range of measures

Chinese herbal medicine for insomnia: evidence, practice and opinions

Evidence-based medicine (EBM) is a contemporary practice paradigm with a focus on improving outcomes of diagnosis and treatment through effective integration of the best available evidence, practitioners’ expertise and individual patients’ preference. In this project, Chinese herbal medicine (CHM) for insomnia is used as an example to illustrate the available evidence and identify CM practitioners’ attitudes, knowledge, skills, behaviours and barriers towards evidence-based practice (EBP). Understanding and addressing these factors will contribute to the enhancement of the practice of Chinese medicine (CM) as well as to set the priorities for CM education, research and policy development. CHM is increasingly used for insomnia in China and worldwide, and has been extensively researched and used in clinical practice. Therefore, it is a suitable exemplar providing insight into EBM in the context of CM practice. Insomnia is the most common sleep-wake disorder with notable health, social and economic burden. Cognitive and behavioural therapy for insomnia (CBT-i) and pharmacotherapy are commonly used to manage symptoms. However, many sufferers seek complementary and alternative medicine (CAM) to improve their sleep and to manage daytime dysfunction. As a form of CAM, Chinese medicine has a long history of use for insomnia and continues to be frequently utilised. Emerging preclinical and clinical evidence suggests that CHM may be beneficial for improving sleep quality. Despite the frequent use of CHM for insomnia it remains largely unclear if CM doctors use EBM to inform their clinical practice. Therefore, this project uses a step-wise approach to understand, firstly, the best available evidence of CHM for insomnia and secondly, to what extent is the evidence being translated into clinical practice. The present study consists of four components: 1) a systematic review (SR) of randomised controlled trials (RCTs); 2) a systematic analysis of the historical literature; 3) a quantitative survey of CM practitioners; and 4) a qualitative interview of CM practitioners. Part One: Current Clinical Evidence of CHM for Insomnia: A Systematic Review and Meta-Analysis This SR with meta-analysis answers the following research questions: Does CHM produce beneficial effects in people with insomnia in terms of sleep quality?’ Does CHM cause any adverse events in people with insomnia and, if so, what is the nature of the adverse events?’ Seventy-nine RCTs involving 7, 886 participants were included in the SR and 76 in the meta-analyses. Findings from this review revealed that CHM improves subjective sleep quality and quantity in people with insomnia. There was no significant difference between CM and the placebo with respect to the frequency and severity of adverse events. Firm conclusions could not be drawn on the comparative effectiveness between CHM and benzodiazepine drugs or psychotherapy due to heterogeneity and risks of bias in the included RCTs. Part Two: Traditional Use of CHM for Insomnia: A Systematic Analysis of the Historical Literature This part of the research answers the following research questions: What Chinese herbal formulae and individual herbs had been referenced and indicated for the treatment of insomnia in the historical literature?’ Is there a difference between traditional and contemporary use of CHM for insomnia and, if so, what are the implications for research and practice?’ The analysis revealed that there were 729 citations involving multi-herb formulae of CHM for insomnia. These herbal formulae were used for people with insomnia based on the CM diagnostic framework. Gender, age and concurrent conditions affected the formulae selection. There has been strong continuity with regard to the clinical application of the most common CHM formulae and herbs for insomnia. Varied CHM formulae might be used according to the distinct phenotypes, stages and severity of insomnia that were traditionally identified as a ‘Syndrome’ or ‘pattern’. By taking together the empirical use, contemporary practice and evidence, Suan zao ren tang and Wen dan tang were the most frequently used and potentially promising candidates for further evaluation and therapeutic development. Part Three: A Quantitative Survey of CM Practitioners Assessing the EBP of CHM for Insomnia This part of the research answers the following research question: What are the CM practitioners’ attitudes, knowledge, skills, behaviours and barriers related to the EBP of CHM for insomnia? A quantitative survey of CM practitioners from the two large academic bodies of CM in Guangdong Province (China) was undertaken. Most survey participants showed positive attitudes to EBM and acknowledged the necessity of applying EBM in the field of CHM for insomnia. More than half of the participants remained conservative about their overall knowledge and skills of EBM. Less than half of participants believed they had implemented EBP of CHM for insomnia, but they appeared to be inactive in seeking clinical practice guidelines to assist in their decision-making. The top barriers to EBP included insufficient high-quality evidence, inadequate research skills to understand EBM and a lack of generalisability of the research findings to patients. Thirteen potential factors were identified that related to EBP of CHM for insomnia. The logistic regression and factor analysis determined the essential factors explaining the behaviours related to EBP of CHM for insomnia, including motivation and goals and the knowledge and skills associated with EBM. Part Four: A Qualitative Interview of CM Practitioners Exploring Their Perspectives on EBM and EBP of CHM for Insomnia The final part of the research explores in greater details the way CM practitioners perceived EBM and their behaviours related to EBP of CHM for insomnia. A qualitative interview of the CM practitioners was conducted. All the interviewees showed positive attitudes to EBM and acknowledged the benefits of EBP of CHM for insomnia. Interviewees demonstrated their understanding of EBM was in line with the commonly understood definition. Also, they understood the importance of critical thinking when they applied senior practitioners’ experience in practice, though they acknowledged the benefits of apprenticeship to improving clinical practice. The barriers to applying contemporary evidence in CM practice were explained within the context of the directness, quality and production of evidence. As a unique characteristic of CM, the principle ‘individualised treatment’ was considered to influence the decision-making and utilisation of CM evidence in EBP. The interviewees indicated that they updated their knowledge of conventional medicine by reading the latest research and clinical practice guidelines. However, they updated their CM knowledge by reading the historical literature and apprenticeship to meet needs of enhancing their clinical practice because of their similarity to clinical scenarios. Based on findings from Parts 3 and 4, a theoretical framework useful for evidence-based CM practice (EBCMP) was constructed by mixed analyses of the quantitative survey (Part 3) and qualitative interview (Part 4). The framework included four factors to improve EBCMP, namely, 1) motivation and goals for EBM, 2) belief about the consequence of EBM, 3) fundamental training of EBM and 4) capacity of EBP. It also included two CM-specific obstacles to EBCMP, namely, 1) the indirectness of CM evidence and 2) the low-quality evidence of CM. Conclusion CHM has a long history of treating insomnia and related symptoms. The key formulae and individual herbs have been consistently used in both ancient and contemporary practice. A meta-analysis indicated that there was promising evidence on the benefit of CHM formulae for improving subjective sleep quality and quantity. When compared with current pharmacotherapy and/or psychotherapy, the effectiveness of CHM was uncertain due to the risk of bias and heterogeneity of the RCTs included in the analyses. Hence, caution should be given when translating these findings into clinical decision making. A survey and an interview of CM practitioners demonstrated their overall positive attitudes towards EBP on CHM for insomnia. Capacity building on EBM and the quality of clinical evidence of CM have been identified as major gaps for promoting EBP. Based on these findings, a theoretical framework has been proposed for enhancing EBCMP. Further evaluation on the effectiveness of this framework is required to strengthen the EBP in CHM for insomnia. Knowledge gained from this process will be transferrable to the global development of CM as a form of EBP that meets the public expectation of evidence generation, evaluation and translation (eGET)

COVID-19 Outbreak and Beyond

The COVID-19 pandemic drastically changed our lifestyle when, on 30 January 2020, the World Health Organization declared the coronavirus disease outbreak a public health emergency of international concern. Since then, many governments have introduced unprecedented containment measures, hoping to slow the spread of the virus. International research suggests that both the pandemic and the related protective measures, such as lockdown, curfews, and social distancing, are having a profound impact on the mental health of the population. Among the most commonly observed psychological effects, there are high levels of stress, anxiety, depression, and post-traumatic symptoms, along with boredom and frustration. At the same time, the behavioral response of the population is of paramount importance to successfully contain the outbreak, creating a vicious circle in which the psychological distress impacts the willingness to comply with the protective measures, which, in turn, if prolonged, could exacerbate the population’s distress. This book includes: i) original studies on the worldwide psychological and behavioral impact of COVID-19 on targeted individuals (e.g., parents, social workers, patients affected by physical and mental disorders); ii) studies exploring the effect of COVID-19 using advanced statistical and methodological techniques (e.g., machine learning technologies); iii) research on practical applications that could help identify persons at risk, mitigate the negative effects of this situation, and offer insights to policymakers to manage the pandemic are also highly welcomed

Everyday life in the puppet state: A study of ordinary people’s experiences in Manchukuo

This thesis explores the experiences of ordinary people living under Japanese occupation in Manchukuo from 1932 to 1945. By examining the harsh nature of colonial rule and the impact on the people, this dissertation shows the multiple ways in which the everyday life of ordinary people was influenced by the various upheavals and hardships. This research mainly uses newspapers, primary published materials, documents, compilations, dictations and other Chinese language sources. This thesis thus establishes a detailed account of the sufferings that colonial subjects encountered in their daily lives and the coping methods that they employed to circumvent them. The experiences of the people were highlighted through the role of education, access to and rationing of goods, the sense of homelessness in the midst of ongoing housing crises, as well as sanitation and hygienic issues, which constituted altogether the core aspects of the everyday life of the people. In essence, ordinary people of Manchukuo lived a life overwhelmed by shortages, misfortunes and difficulties. Focusing on both rural and urban areas, this thesis argues how the people of Manchukuo were passive in face of the various policies implemented by the regime, but yet active in face of the hardships that followed. This sense of passivity, or the general lack of initiative, demonstrates in fact how motives of self-protection and survival beneath the acts of superficial compliance directed the people’s everyday life in Manchukuo. With the current literature’s emphasis on the economic and social structures of the puppet state, this thesis seeks to fill the gap by recognizing the importance of the everyday experiences of the colonial subjects

The Impact of the COVID-19 Emergency on the Quality of Life of the General Population

COVID-19 is a pandemic that has forced many states to declare restrictive measures in order to prevent its wider spread. These measures are necessary to protect the health of adults, children, and people with disabilities.Long quarantine periods could cause an increase in anxiety crises, fear of contagion, and post-traumatic stress disorder (frustration, boredom, isolation, fear, insomnia, and difficulty concentrating).Post-traumatic stress disorder (PTSD) is a condition that can develop in subjects who have witnessed a traumatic, catastrophic, or violent event, or who have become aware of a traumatic experience that happened to a loved one.In fact, from current cases, it emerges that the prevalence of PTSD varies from 1% to 9% in the general population and can reach 50%–60% in subgroups of subjects exposed to traumas considered particularly serious. PTSD develops as a consequence of one or more physical or psychological traumatic events, such as exposure to natural disasters such as earthquakes, fires, floods, hurricanes, tsunamis; wars, torture, death threats; road accidents, robbery, air accidents; diseases with unfavorable prognoses; complicated or traumatic mourning; physical and sexual abuse and abuse during childhood; or victimization and discrimination based on gender, sexual orientation, or gender identity. It can also develop following changes in lifestyle habits caused by the COVID-19 epidemic.Thank you for reading the manuscripts in this Special Issue, "The Impact of the COVID-19 Emergency on the Quality of Life of the General Population"

The Impact of the COVID-19 Emergency on the Quality of Life of the General Population

COVID-19 is a pandemic that has forced many states to declare restrictive measures in order to prevent its wider spread. These measures are necessary to protect the health of adults, children, and people with disabilities. Long quarantine periods could cause an increase in anxiety crises, fear of contagion, and post-traumatic stress disorder (frustration, boredom, isolation, fear, insomnia, difficulty concentrating). Post-traumatic stress disorder (PTSD) is a condition that can develop in subjects who have been or have witnessed a traumatic, catastrophic, or violent event, or who have become aware of a traumatic experience that happened to a loved one. In fact, from current cases, it emerges that the prevalence of PTSD varies from 1% to 9% in the general population and can reach 50%–60% in subgroups of subjects exposed to traumas considered particularly serious. PTSD develops as a consequence of one or more physical or psychological traumatic events, such as exposure to natural disasters such as earthquakes, fires, floods, hurricanes, tsunamis; wars, torture, death threats; road accidents, robbery, air accidents; diseases with unfavorable prognoses; complicated or traumatic mourning; physical and sexual abuse and abuse during childhood; victimization and discrimination based on gender, sexual orientation, gender identity. It can also develop following changes in lifestyle habits caused by the COVID-19 epidemic

Remoulding the Chinese mind : mental hygiene promotion in Republican Shanghai

In this thesis, I uncover the history of the Mental Hygiene Movement in Republican Shanghai. I show that it had a far-reaching role to play in the city, promoting mental hygiene throughout China and influencing other cities like Canton, Peking, and Chongqing. This movement could be dated from the 1910s but achieved a dramatic expansion in the 1930s before being attenuated in warfare in the 1940s and coming to an end with the foundation of the PRC. Chinese intellectuals and foreign missionaries and experts, despite their different aims, jointly promoted this movement, and it reached out to the Chinese populace through the public media. Mental hygiene arose from the conjuncture of a new understanding toward the mind and mental problems, the establishment of asylums and psychiatric hospitals, new tools of mass publicity available to the government and a range of non-governmental institutes. In addition, development in Shanghai was powerfully shaped by politics and ideology. Initially, mental hygiene emerged in relation to a colonial aim of regulating the unwanted on streets and creating public hygiene and order. Subsequently, Shanghai would increasingly see a strong revolutionary and political influence in remoulding the ‘national’ mind. In particular, nationalism and modernism were powerful factors in development. More generally, the progressive ideology of scienfication lay behind the development of disciplines and clinics. Shanghai was part of the international history of mental hygiene, but it also demonstrates the importance of locality. For both Chinese governments and the populace, the significance of the Mental Hygiene Movement was more symbolic than pragmatic. The ideological project of remoulding the mind outweighed medical research and the treatment of mental illnesses. I argue that the reason psychiatric policies were not facilitated in China on a large scale was due to the lack of a powerful government force. The acceptance of mind remoulding and self-improvement, however, was more pervasive. One reason for this was that it benefited from the inheritance of a tradition of self-introspection. The Chinese Mental Hygiene movement, therefore, reflected novelty and Western influence but also a convention. Intellectual radicalism was questioned in the process of popularisation and was modified to become more pragmatic in line with everyday practices. Traditional thinking about the mind, while under fierce critique from the modernisers, showed resilience in compromising and integrating new knowledge and ideologies

Internet and Smartphone Use-Related Addiction Health Problems: Treatment, Education and Research

This Special Issue presents some of the main emerging research on technological topics of health and education approaches to Internet use-related problems, before and during the beginning of coronavirus disease 2019 (COVID-19). The objective is to provide an overview to facilitate a comprehensive and practical approach to these new trends to promote research, interventions, education, and prevention. It contains 40 papers, four reviews and thirty-five empirical papers and an editorial introducing everything in a rapid review format. Overall, the empirical ones are of a relational type, associating specific behavioral addictive problems with individual factors, and a few with contextual factors, generally in adult populations. Many have adapted scales to measure these problems, and a few cover experiments and mixed methods studies. The reviews tend to be about the concepts and measures of these problems, intervention options, and prevention. In summary, it seems that these are a global culture trend impacting health and educational domains. Internet use-related addiction problems have emerged in almost all societies, and strategies to cope with them are under development to offer solutions to these contemporary challenges, especially during the pandemic situation that has highlighted the global health problems that we have, and how to holistically tackle them

ATHENA Research Book

The ATHENA European University is an alliance of nine Higher Education Institutions with the mission of fostering excellence in research and innovation by facilitating international cooperation. The ATHENA acronym stands for Advanced Technologies in Higher Education Alliance. The partner institutions are from France, Germany, Greece, Italy, Lithuania, Portugal, and Slovenia: the University of Orléans, the University of Siegen, the Hellenic Mediterranean University, the Niccolò Cusano University, the Vilnius Gediminas Technical University, the Polytechnic Institute of Porto, and the University of Maribor. In 2022 institutions from Poland and Spain joined the alliance: the Maria Curie-Skłodowska University and the University of Vigo. This research book presents a selection of the ATHENA university partners' research activities. It incorporates peer-reviewed original articles, reprints and student contributions. The ATHENA Research Book provides a platform that promotes joint and interdisciplinary research projects of both advanced and early-career researchers