No abstract

Insomnia is a common symptom, with chronic insomnia being diagnosed in 5–10% of adults. Although many insomnia patients use prescription therapy for insomnia, the health benefits remain uncertain and adverse risks remain a concern. While similar effectiveness and risk concerns exist for herbal remedies, many individuals turn to such alternatives to prescriptions for insomnia. Like prescription hypnotics, herbal remedies that have undergone clinical testing often show subjective sleep improvements that exceed objective measures, which may relate to interindividual heterogeneity and/or placebo effects. Response heterogeneity can undermine traditional randomized trial approaches, which in some fields has prompted a shift toward stratified trials based on genotype or phenotype, or the so-called n-of-1 method of testing placebo versus active drug in within-person alternating blocks. We reviewed six independent compendiums of herbal agents to assemble a group of over 70 reported to benefit sleep. To bridge the gap between the unfeasible expectation of formal evidence in this space and the reality of common self-medication by those with insomnia, we propose a method for guided self-testing that overcomes certain operational barriers related to inter- and intraindividual sources of phenotypic variability. Patient-chosen outcomes drive a general statistical model that allows personalized self-assessment that can augment the open-label nature of routine practice. The potential advantages of this method include flexibility to implement for other (nonherbal) insomnia interventions.

Despite extensive inclusion and diversity initiatives, females do not feel valued or included and still report higher stress, discrimination and microaggressions than males. Cumulative effects of social devaluation on health were examined for students at a STEM University. A sample of 292 undergraduates were asked about daily and chronic experiences of inclusion using surveys assessing personal perceived stress and subtle and overt social devaluation. Females reported significantly higher microaggressions and perceived stress, associated with lower physical and mental health. Females in high social devaluation (SD) reported lower total well-being (TWB) across several domains. An exploratory factor analyses examined factor loadings on perceptions of devaluation and extracted three factors; results showed that females and males perceive the poor treatments for markedly different reasons. Stress, low sense of control, objectification, and lack of positive exemplars varied by sex. These data suggest persistent implicit biases remain entrenched for females in STEM. This was unexpected since multiple early inclusion interventions exist. Inclusion initiatives may need to be reviewed specifically to address implicit attitudes and internalized acquiescence, training female students to explicitly interface with such experiences.