Differences in Face-to-Face Time Spent With a Dermatologist Among Patients With Psoriasis Based on Race and Ethnicity

Kevin K. Wu, MD¹; April W. Armstrong, MD, MPH¹

Author Affiliations Article Information

JAMA Dermatol. Published online August 3, 2022. doi:10.1001/jamadermatol.2022.2426

Psoriasis is a chronic inflammatory skin condition frequently managed by dermatologists. Dermatologists have an obligation to provide each patient with psoriasis with adequate time to address their concerns and develop strong communication and trust. Ineffective physician-patient communication can mean poor treatment adherence, comprehension, satisfaction, and outcomes for the patient.¹ It is unclear whether differences exist in the amount of time a dermatologist spends with a patient with psoriasis based on race or ethnicity. We aimed to evaluate the association between a patient’s race and ethnicity and time spent with a dermatologist for psoriasis treatment.

Methods

We performed a cross-sectional study of data from the National Ambulatory Medical Care Survey from 2010 through 2016.² Data were analyzed January 3 to April 24, 2022. We conducted multivariable linear regression analyses adjusted for age, sex, type of visit (follow-up or new patient), visit complexity based on the number of reasons for visit, insurance status, psoriasis severity on the basis of systemic psoriasis treatment or phototherapy, and complex topical regimen (3 or more topical agents) to evaluate the association between patient race and ethnicity and visit duration for psoriasis treatment with a dermatologist. Race and ethnicity were self-reported by patients. The eMethods in the Supplement provides further details. This study was categorized as exempt by the University of Southern California Institutional Review Board, and the requirement for informed consent was waived because only deidentified data were used. We followed the STROBE reporting guideline. Statistical tests were 2-tailed, and a 2-sided P < .05 was considered statistically significant.

Results

A weighted estimate of 4 201 745 (95% CI, 3 688 629-4 714 862) patient visits for psoriasis was identified. Of the tabulated demographic characteristics, a significant difference existed in age (37.2 [95% CI, 32.0-42.4] years for Asian patients vs 44.7 [95% CI, 33.4-56.0] years for Hispanic patients vs 33.3 [95% CI, 16.9-49.7] years for Black patients vs 54.8 [95% CI, 51.6-58.0] years for White patients; P = .001) and complex topical regimen (11.8% among Asian patients vs 1.5% among Black patients vs 1.1% among White patients; P = .03) among the groups (Table 1). Mean duration of visits was 9.2 (95% CI, 4.4-14.1) minutes with Asian patients, 15.7 (95% CI, 14.2-17.3) minutes with Hispanic or Latino patients, 20.7 (95% CI, 14.5-26.9) minutes with non-Hispanic Black patients, and 15.4 (95% CI, 13.5-17.3) minutes with non-Hispanic White patients. Visits with Asian patients had a 39.9% shorter mean duration compared with visits with White patients (β coefficient, −5.747 [95% CI, −11.026 to −0.469]; P = .03) and a 40.6% shorter mean duration compared with visits with non-Asian patients as a single group (β coefficient, −5.908 [95% CI, −11.147 to −0.669]; P = .03) (Table 2).

Discussion

Results of the present study suggest that Asian patients with psoriasis receive significantly less face-to-face time with a dermatologist compared with patients of other races and ethnicities. This study supports the results of previous studies in which Asian patients were found to be less likely to receive counseling from physicians compared with White patients.^3,4 Paradoxically, Asian individuals tend to present with more severe psoriasis compared with individuals of other races and ethnicities.⁵

The etiology of these differences is unclear. It is possible that factors, such as unconscious bias, cultural differences in communication, or residual confounding may be responsible for the observed findings.^3,6 Further research is needed to understand the underlying factors responsible for the differences observed in this study.

This study has limitations. Visit duration was self-reported by the physician or their staff and had been studied in other fields; formal validation studies are pending. Missing data on race and ethnicity were imputed using a sequential regression method.² It is possible that those patients who did not report race and ethnicity may have different characteristics affecting visit duration vs those who did report this information.

Dermatologists spend less time with Asian patients with psoriasis compared with patients of other races and ethnicities. Dermatologists need to allow sufficient time to develop strong physician-patient communication regardless of patient background.

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Article Information

Accepted for Publication: May 6, 2022.

Published Online: August 3, 2022. doi:10.1001/jamadermatol.2022.2426

Corresponding Author: April W. Armstrong, MD, MPH, Department of Dermatology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, KAM 510, MC 9034, Los Angeles, CA 90089 (armstrongpublication@gmail.com).

Author Contributions: Dr Wu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Wu.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Wu.

Administrative, technical, or material support: All authors.

Supervision: Armstrong.

Conflict of Interest Disclosures: Dr Armstrong reported receiving personal fees from AbbVie and Regeneron for research funding and serving as a scientific adviser and speaker; Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly & Co., Janssen, Novartis, and UCB Pharma for research funding and serving as a scientific adviser; Modernizing Medicine Ortho Dermatologics, Sanofi Genzyme, Sun Pharma, Pfizer, Almirall, Arcutis Biotherapeutics, ASLAN Pharmaceuticals, Beiersdorf, EPI Health, Incyte, and Nimbus Therapeutics for serving as a scientific adviser; and Boehringer Ingelheim and Parexel for serving as a Data Safety Monitoring Board member outside the submitted work. No other disclosures were reported.

Disclaimer: Dr Armstrong is on the Editorial Board of JAMA Dermatology, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.

References

1.

Stewart  MA.  Effective physician-patient communication and health outcomes: a review.   CMAJ. 1995;152(9):1423-1433.PubMedGoogle Scholar

2.

Ambulatory health care data: about the ambulatory health care surveys. Centers for Disease Control and Prevention National Center for Health Statistics. Updated December 30, 2021. Accessed January 30, 2019. https://www.cdc.gov/nchs/ahcd/about_ahcd.htm

3.

Ngo-Metzger  Q, Legedza  AT, Phillips  RS.  Asian Americans’ reports of their health care experiences: results of a national survey.   J Gen Intern Med. 2004;19(2):111-119. doi:10.1111/j.1525-1497.2004.30143.xPubMedGoogle ScholarCrossref

4.

Murray-García  JL, Selby  JV, Schmittdiel  J, Grumbach  K, Quesenberry  CP  Jr.  Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization.   Med Care. 2000;38(3):300-310. doi:10.1097/00005650-200003000-00007PubMedGoogle ScholarCrossref

5.

Shah  SK, Arthur  A, Yang  YC, Stevens  S, Alexis  AF.  A retrospective study to investigate racial and ethnic variations in the treatment of psoriasis with etanercept.   J Drugs Dermatol. 2011;10(8):866-872.PubMedGoogle Scholar

6.

Saposnik  G, Redelmeier  D, Ruff  CC, Tobler  PN.  Cognitive biases associated with medical decisions: a systematic review.   BMC Med Inform Decis Mak. 2016;16(1):138. doi:10.1186/s12911-016-0377-1PubMedGoogle ScholarCrossref

Augmented reality could be the future of paper books, according to new research 

Peer-Reviewed Publication

UNIVERSITY OF SURREY

 

IMAGE: NEXT GENERATION PAPER BOOK EXAMPLE view more 

CREDIT: COURTESY OF ADVANCED TECHNOLOGY INSTITUTE

 

Augmented reality might allow printed books to make a comeback against the e-book trend, according to researchers from the University of Surrey.  

Surrey has introduced the third generation (3G) version of its Next Generation Paper (NGP) project, allowing the reader to consume information on the printed paper and screen side by side.  

Dr Radu Sporea, Senior lecturer at the Advanced Technology Institute (ATI), comments: 

“The way we consume literature has changed over time with so many more options than just paper books. Multiple electronic solutions currently exist, including e-readers and smart devices, but no hybrid solution which is sustainable on a commercial scale.  

“Augmented books, or a-books, can be the future of many book genres, from travel and tourism to education. This technology exists to assist the reader in a deeper understanding of the written topic and get more through digital means without ruining the experience of reading a paper book.” 

Power efficiency and pre-printed conductive paper are some of the new features which allow Surrey’s augmented books to now be manufactured on a semi-industrial scale. With no wiring visible to the reader, Surrey’s augmented reality books allow users to trigger digital content with a simple gesture (such as a swipe of a finger or turn of a page), which will then be displayed on a nearby device.  

George Bairaktaris, Postgraduate researcher at the University of Surrey and part of the Next Generation Paper project team, said: 

“The original research was carried out to enrich travel experiences by creating augmented travel guides. This upgraded 3G model allows for the possibility of using augmented books for different areas such as education. In addition, the new model disturbs the reader less by automatically recognising the open page and triggering the multimedia content.” 

“What started as an augmented book project, evolved further into scalable user interfaces. The techniques and knowledge from the project led us into exploring organic materials and printing techniques to fabricate scalable sensors for interfaces beyond the a-book”.  

More information on the upgraded 3G augmented reality book will appear in IEEE Pervasive Computing magazine, which can be found here. 

Ends 

Notes to Editors

• Research on the 2G ‘augmented reality-book’ was published in e-Review of Tourism Research in 2019 by Dr Emily Corrigan-Kavanagh 

• More information on this research can be found here : http://teamsporea.info/research/user_interfaces/ 

• Dr Radu Sporea is available for interview upon request 

• Contact the University’s press office via mediarelations@surrey.ac.uk 

 

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JOURNAL

IEEE Pervasive Computing

DOI

10.1109/MPRV.2022.3181440 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Augmented Books: Hybrid Electronics Bring Paper to Life

More women turning to medical cannabis for relief of menopause symptoms

New study finds that a growing number of primarily perimenopausal women are using medical cannabis to treat menopause symptoms such as sleep disturbance and mood/anxiety

Peer-Reviewed Publication

THE NORTH AMERICAN MENOPAUSE SOCIETY (NAMS)

CLEVELAND, Ohio (August 3, 2022)—The legalization of medical cannabis has led to its use in treating a growing number of health problems. A new study suggests that it is becoming more common for women to use medical cannabis for menopause-related symptoms. Perimenopausal women, who report significantly worse menopause symptoms (particularly depression), represent the greatest percentage of users. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Hormone changes associated with menopause are responsible for causing a wide array of bothersome symptoms, including hot flashes, sleep disturbance, depressed mood, and anxiety. Although several treatment options, particularly hormone therapy, have proven effective in managing these symptoms, not all women are able or willing to use these options. This has led to the ongoing search for more nonhormone treatment options.

Several observational studies previously demonstrated that medical cannabis use is associated with various clinical benefits, including improvements on measures of anxiety, mood, sleep, and pain, as well as cognitive improvement after treatment. But no studies to date have examined the safety and efficacy of medical cannabis to alleviate menopause-related symptoms.

In this new study involving more than 250 perimenopausal and postmenopausal women who were recruited through advertising targeted to women interested in women’s health and cannabis or cannabinoids, researchers sought to assess cannabis use, including modes of use, and to compare usage patterns between perimenopausal and postmenopausal women. Results suggested that many women (86%) currently use cannabis as an adjunct treatment for menopause-related symptoms via a variety of different modes of use, with the most common being smoking (84.3%) and edibles (78.3%). The most frequently reported indications for medical cannabis use were menopause-related disturbances of sleep and mood/anxiety.

Compared with postmenopausal participants, perimenopausal participants reported significantly worse menopause-related symptomatology, including more anxiety and hot flashes. Perimenopausal women were also more likely to report a higher incidence of depression and anxiety, as well as increased use of medical cannabis to treat these symptoms. Additional research is necessary to confirm the effectiveness of cannabis for the treatment of various menopause symptoms.

Study results are published in the article “A survey of medical cannabis use during perimenopause and postmenopause.”

“This study suggests that medical cannabis use may be common in midlife women experiencing menopause-related symptoms. Given the lack of clinical trial data on the efficacy and safety of medical cannabis for management of menopause symptoms, more research is needed before this treatment can be recommended in clinical practice. Healthcare professionals should query their patients about the use of medical cannabis for menopause symptoms and provide evidence-based recommendations for symptom management,” says Dr. Stephanie Faubion, NAMS medical director.

For more information about menopause and healthy aging, visit www.menopause.org.

Founded in 1989, The North American Menopause Society (NAMS) is North America’s leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging. Its multidisciplinary membership of 2,000 leaders in the field—including clinical and basic science experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education—makes NAMS uniquely qualified to serve as the definitive resource for health professionals and the public for accurate, unbiased information about menopause and healthy aging. To learn more about NAMS, visit www.menopause.org.

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JOURNAL

Menopause

DOI

10.1097/GME.0000000000002018 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

A survey of medical cannabis use during perimenopause and postmenopause

Gender affects driverless car performance

Peer-Reviewed Publication

NEWCASTLE UNIVERSITY

Newcastle University research has shown that women respond quicker and exhibit more stable takeover control than men in automated cars.

The study focussed on level 3 automated vehicles (L3 AVs), which allow drivers to be completely disengaged from driving and perform non-driving related activities. However, in L3 AVs human drivers’ intervention in the control of the vehicle may still be required in some situations, such as no signal or network connections, and places without complete road signage and markings.

The driving simulator study involved 76 drivers (33 females and 43 males), who were asked to take over control from L3 AVs in different weather conditions, with researchers measuring the timing and quality of takeover.

Published in the journal Nature Scientific Reports, the results show that gender significantly affects takeover performance. Compared to men, women exhibited a smaller percentage of hasty takeovers and slightly faster reaction times as well as slightly more stable operation of the steering wheel.

Study Lead Author, Dr Shuo Li, of Newcastle University’s School of Engineering, said: “Our research strengthens the importance of tackling inequality in the context of future mobility. To create user-friendly automated vehicles, the manufacturers and designers need to adopt inclusive practices which fully consider the needs, requirements, performance, and preferences of end-users from different demographic groups.

“The next step, follow-up research is planned to explore gender differences in the needs and requirements associated with non-driving related tasks in Level 3 automated vehicles and investigate the effect of performing these tasks on end-users' behaviour and performance.”

Study Co-Author, Professor Phil Blythe, Professor of Intelligent Transport Systems at Newcastle University’s School of Engineering, added: “This research is part of a wider programme of work which is helping us understand the issue and challenges of designing automated vehicles in a way that end users will be able to understand and use safely.”

The findings of this paper have important implications for policymakers, the vehicle manufacturers  and academics for designing and facilitating user-friendly human–machine interactions in L3 AV.

The results also highlight that it is important for both genders to recognise they can use and interact with L3 AVs well, however more hands-on experience and teaching sessions could be provided to deepen their understanding of L3 Avs particularly at the point when the driver is required to retake manual control of the vehicle.

The researcher argue that design of the car interiors of L3 AVs should also take into account gender differences in the preferences of users for different non-driving related tasks, however the overriding requirement is to keep the required user interface and take-over tasks as simple as possible with a standard way of doing this irrespective of vehicle model.

Reference

Li, S., Blythe, P., Zhang, Y. et al. Analysing the effect of gender on the human–machine interaction in level 3 automated vehicles. Sci Rep 12, 11645 (2022). https://doi.org/10.1038/s41598-022-16045-1

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JOURNAL

Scientific Reports

DOI

10.1038/s41598-022-16045-1 

METHOD OF RESEARCH

Computational simulation/modeling

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Analysing the effect of gender on the human–machine interaction in level 3 automated vehicles

Having a partner more important than children to staving off loneliness during pandemic, new study finds

Peer-Reviewed Publication

UNIVERSITY OF RHODE ISLAND

KINGSTON, R.I. – August 3, 2022 – A new study released in the European Journal of Ageing found that having a partner had a greater impact than having children in helping to stave off loneliness among older adults during the pandemic’s first wave. Researchers at the University of Rhode Island, University of Florence, University of Maryland Baltimore County and the SGH Warsaw School of Economics analyzed data on more than 35,000 adults aged 50 and older from the Survey of Health, Ageing and Retirement in Europe to examine if unpartnered and childless older adults reported more loneliness and how that changed over the course of the pandemic.

Prior to the pandemic when asked “have you felt lonely recently?” those older adults who lacked one tie but had the other (unpartnered parents or partnered childless) were at greater risk for loneliness. However, during the pandemic, this combined status mattered less. More significant was the independent status of being either without a partner or childless. And specifically, not having a partner had the greatest bearing on loneliness.

During the pandemic’s first wave respondents were asked “have you felt lonely recently?” and “have you felt lonelier than before the pandemic?” While those without a partner and those without children were both more likely to experience loneliness, the unpartnered were more likely to undergo a more significant shift in their loneliness.

According to URI Assistant Professor of Health Studies Nekehia Quashie, one of the authors of the study, “What we found is that those without a partner had a higher risk of being lonely – even if they were not lonely prior to the pandemic. They had a higher risk of moving into loneliness – more so than those who had no children.”

Those who were lonely prior to the pandemic were less likely to exit loneliness, regardless of their status, said Quashie.

In the decade preceding the pandemic academics and public health officials have been increasingly concerned about loneliness, particularly among older adults, for a variety of reasons. With the advent of the COVID-19 pandemic and mitigation efforts centered squarely on measures like “physical distancing” and minimizing social interactions outside one’s immediate household, this heightened concern – especially for groups that were already at a greater risk for loneliness, said Quashie on the reason for the study.

Interestingly, “kinless” older adults (unpartnered and childless), while still at risk for loneliness, were not lonelier than the other two groups (unpartnered parents, partnered childless) prior to the pandemic. To researchers’ surprise, this held true over the course of the pandemic. 

“With those who are ‘kinless,’ it’s possible they have developed a range of resources and different coping strategies to manage a situation where they don’t have large networks to rely on – whether that is an immediate personal crisis or, as we saw in the pandemic, a major public health crisis,” said Quashie.

She added, “Remember that the concept of loneliness is very subjective – essentially we see loneliness arise when one’s desired or expected social interactions don’t match with their reality. So people have different thresholds for loneliness.”

While the study did not examine well-being outcomes such as anxiety and depression, the results highlight the increased risk for loneliness among certain groups – both prior to and during the pandemic. As the population of unpartnered and childless older adults grows globally it will be important for public health officials to take into account how measures intended to mitigate the spread of COVID-19, which limited social interaction, affected those groups already at higher risk for loneliness and consider approaches which limit social isolation.

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JOURNAL

European Journal of Ageing

DOI

10.1007/s10433-022-00718-x 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Loneliness before and during the COVID-19 pandemic—are unpartnered and childless older adults at higher risk?

Genes involved in heart disease are similar across all populations, VA study finds

Peer-Reviewed Publication

VETERANS AFFAIRS RESEARCH COMMUNICATIONS

The genes involved in coronary heart disease, the most common form of heart disease, appear to be nearly the same for everyone, according to a VA study.

Roughly one-third to one-half of everyone’s chances for developing this type of heart disease are rooted in their genes. This genetic risk seems to be the same across all major racial and ethnic backgrounds, including people of European, African, Japanese, and Indigenous ancestries, the VA study found. 

“Some groups, such as African Americans, are more likely to suffer from heart disease, and our findings indicate that’s not because they have a higher genetic risk for the disease,” says study author Dr. Catherine Tcheandjieu, a genetic epidemiologist at the VA Palo Alto Health Care System and University of California San Francisco. “It confirms that other factors are responsible for more heart disease in those populations, such as access to health care and different lived experiences,” she adds.

The genetic study—the largest to date on heart disease—was published August 1, 2022, in Nature Medicine. It looked at nearly a quarter of a million cases of coronary heart disease, including more than 100,000 U.S. Veterans with the disease.

Coronary artery disease is the leading cause of death in the United States, responsible for one in every five deaths. It occurs when major blood vessels to the heart muscle become narrowed or blocked, which can lead to heart attack.

The study was led by investigators at the Palo Alto VA and involved researchers from several other VAs across the nation.

Research into the genetics of heart disease, like many other areas of health research, is mostly based on data from white people because of higher participation.

The Nature Medicine study, on the other hand, examined the genes of more than 27,000 Black and 12,000 Hispanic people with coronary artery disease. Most of these were Veterans, who agreed to share their genetic and health information for research as part of VA’s Million Veteran Program, also known as MVP.

With data from MVP, VA researchers in this study confirmed for the first time that many genetic variations known to heighten heart disease risk in white people have the same effect in people of African and Hispanic ancestry. Additionally, researchers found nearly 100 new locations on the human genome where variations appear to increase risk of coronary artery disease.

To find these locations in the human genome that are linked to heart disease, researchers in the study carefully looked at the genes of nearly a quarter of a million people with heart disease and compared them to more than 840,000 people without the disease.

“Ours is the first genetic study of coronary artery disease that had enough people of African and Hispanic descent to confirm previous findings in white people,” says corresponding author Dr. Themistocles (Tim) Assimes, a cardiologist and researcher at the VA Palo Alto Health Care System and Stanford University. “This was directly because of VA’s Million Veteran Program.”

Among nearly 900,000 Veterans in MVP, close to 150,000 are Black and more than 70,000 are Hispanic, making MVP one of the richest sources of data available for genetic research on all people, including those from diverse racial and ethnic backgrounds.

In 2007, researchers identified a gene termed the “heart attack gene” that can lead to up to a 50% lifetime chance of developing heart disease. For more than a decade, researchers have known this gene is linked to higher chances of early and more severe heart disease in white, South Asian, and East Asian populations. But genetic studies never had enough people of other ancestries to determine whether the same held true for other populations.

That is, until now.

As part of the Nature Medicine study, VA researchers were able to show that the region of DNA where this “heart attack gene” sits appears to play much less of a role in altering the risk of disease among people with African ancestry, including a majority of African Americans and many Hispanics.

This is because the genetic miscoding, also known as a genetic variation, does not exist in people with African ancestry.

“It’s possible other ‘heart attack’ genes exist in Black populations,” Assimes adds, “but to find out, we need to do more research and make it a priority to invite many more people with African origins to participate in our genetic studies.”

Researchers from this study used their findings to create new genetic tests to better predict who might develop coronary heart disease in the future. These new tests are not much different than cholesterol, blood pressure, and diabetes tests, except they provide an idea of how high or low someone’s inherited risk of heart disease is from birth.

“The impacts of this study on health care are happening now,” explains Tcheandjieu. She acknowledges, however, more fine-tuning needs to be done to fully capture genetic risk in Black people.

“The best way to improve these genetic tests, also known as polygenic risk scores, is to study more people of African background such as African and Hispanic Americans, as well as people from Africa. This will allow us to discover all the miscodings in genes that increase risk for heart disease in diverse populations and make sure these tests capture that,” says Assimes.

An important next step is to see how well these new genetic tests accurately predict one’s risk for heart disease, say the researchers. The way to do that is through clinical trials, where researchers compare health outcomes for people who received genetic testing compared to people who didn’t.

For now, this study establishes a solid foundation for researchers to begin building the future of individualized heart health for everyone.

---

JOURNAL

Nature Medicine

DOI

10.1038/s41591-022-01891-3 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Large-scale genome-wide association study of coronary artery disease in genetically diverse populations

Cannabidiol effective for young people with treatment-resistant anxiety – pilot study

Cannabidiol may halve the severity of chronic anxiety symptoms and impairment in young people, an Orygen pilot study has shown

Peer-Reviewed Publication

ORYGEN

Cannabidiol may be effective in halving the severity of symptoms and impairment caused by chronic anxiety, a pilot study by Orygen, Australia’s centre of excellence in youth mental health, has shown.

The Cannabidiol Youth Anxiety Pilot Study found that young people with treatment-resistant anxiety had an average 42.6 per cent reduction in anxiety severity and impairment following 12 weeks’ treatment with cannabidiol – a non-intoxicating component of the Cannabis sativa plant which is often referred to as CBD.

Orygen’s Professor Paul Amminger, who led the study, said this level of improvement was remarkable.

“The young people had fewer panic attacks and could do things which they were previously unable to do like leave the house, go to school, participate in social situations, eat at restaurants, take public transport or attend appointments by themselves,” Professor Amminger said.

“That's an amazing change in the group which has had treatment-resistant, long-standing severe to very severe anxiety.”

The reduction in symptoms was observed on two different scales: a clinician rated scale (the Hamilton Anxiety Rating, 50.7 per cent) and a self-rated scale (the Overall Anxiety Severity and Impairment Scale, 42.6 per cent), which involved participants filling in a questionnaire on symptoms such as panic attacks, situational anxieties, worries and flashbacks.

Study co-investigator and Orygen Executive Director, Professor Patrick McGorry said the findings held promise for a significant number of young people, with Australian Bureau of Statistics data released on 22 July showing anxiety was the most common form of mental ill-health in young people, affecting nearly a third (31.5 per cent) of those aged 16–24 – almost double the rate of the general population.

“We’re seeing more and more young people experiencing anxiety – it’s the fasting growing form of mental ill-health in young people and we urgently need innovation in treatment. Cannabidiol is a promising treatment option which appears safe and effective. We need further research to confirm this and explore its value,” Professor McGorry said.

The pilot study involved 31 participants aged 12–25 who were recruited from Orygen’s primary care services. The participants had a diagnosed anxiety disorder and had failed to show significant improvement in anxiety severity following at least five cognitive behavioural therapy (CBT) sessions.

“The problem with current frontline treatments for anxiety – CBT and selective serotonin reuptake inhibitor (SSRI) antidepressant drugs – is that they only work in about half of the people who try them,(1, 2)” Professor Amminger said.

“Anxiety disorders are very common so that leaves a large number of young people untreated, struggling with symptoms and developing secondary conditions, for instance depression and substance use disorders.”

Orygen started exploring cannabidiol as an anxiety treatment after it was found to be effective in reducing anxiety in adults.(3, 4, 5, 6)

In Australia, cannabidiol has been approved by the Therapeutic Goods Administration as a treatment for children with rare forms of epilepsy (Dravet syndrome and Lennox Gastaut syndrome).(7) Cannabidiol has been approved for clinical trials as a treatment for children in Australia with Tourette Syndrome, Fragile X syndrome, autism spectrum disorder and intellectual disability.(8)

“It’s important to stress that cannabidiol does not induce any significant side effects or lead to the emergence of any neurological or psychiatric manifestations,” Professor Amminger said.

“Cannabidiol is non-intoxicating and doesn’t contain tetrahydrocannabinol (THC) so it doesn’t cause alterations in thinking and perception, it doesn’t make you ‘high’ and it’s not addictive. In fact, cannabidiol has been used to treat addictive behaviours in other research trials and can reduced some of the adverse and intoxicating effects of THC.(9)”

Pilot study participants’ starting dose was one 200mg capsule of cannabidiol per day, which was increased to 400mg after one week. Those who did not show significant improvement in anxiety symptoms had their dosage increased at 200mg increments up to 800mg per day. All participants were offered biweekly CBT for 12 weeks (five sessions).

“Our pilot study found that cannabidiol not only helped to reduce anxiety symptoms but it was also very well tolerated – the most common side-effects were mild sedation and mild fatigue but that was at the time when doses were increased and usually went away after a couple of days,” Professor Amminger said.

“We did not see side-effects like suicidal thoughts, irritability or sleep problems, which are not uncommon in people taking SSRIs.”

Although the findings are promising, further research is required.

“An open-label pilot study is limited by its design. To see a treatment effect in the treatment-resistant group is encouraging, but it could still be a placebo effect. The next step is a randomised controlled trial, which is the gold standard to test a new intervention. Such a trial needs to be done in a much larger group – around 200 to 250 young people – to enable us to say with some certainty that there is, or is not, real treatment benefits and effects,” Professor Amminger said.

The trial received financial and specialist technical support from the Lambert Initiative for Cannabinoid Therapeutics at the University of Sydney, a philanthropically-funded research program specialising in the development of cannabis-based therapies to alleviate human suffering.

Study co-investigator and Orygen Executive Director, Professor Patrick McGorry, is available for media interviews about the findings on Monday 1 August and Tuesday 2 August.

A short video about the findings is available here: https://vimeo.com/733870128/d66a2367ac

The content of this press release and video is strictly embargoed until 4 August, 3am AEST.

Media contact

Thea Cowie
Senior communications advisor
+61 447 675 698
thea.cowie@orygen.org.au

FAQ

What is cannabidiol?

• Cannabidiol is a non-intoxicating component of the Cannabis sativa plant. This means it does not cause alterations in thinking and perception, such as those caused by tetrahydrocannabinol (THC).
• Cannabidiol is not the same as cannabis. Cannabidiol is a component that is enriched in the “hemp” strains of cannabis. Unlike other substances found in the cannabis plant (for example, tetrahydrocannabinol (THC)), cannabidiol does not get you ‘high’.
• Cannabidiol is often referred to as CBD.
• Cannabidiol is not addictive. In fact, there is emerging evidence that it may help to treat addiction to other drugs such as alcohol, methamphetamine and high-THC cannabis.(9)
• Cannabidiol does not induce any significant side effects or lead to the emergence of any neurological, psychiatric or general clinical manifestations.(12)
• Cannabidiol has been tested in healthy research participants and in adults with anxiety disorders. In these studies cannabidiol has been found to reduce anxiety.(3, 4, 5, 6)
• The cannabidiol in this trial was supplied by Biosynthesis Pharma Group (BSPG). BSPG’s cannabidiol is purified to more than 99.5 per cent.

What did the pilot study involve?

The Cannabidiol Youth Anxiety Pilot Study (CAPS) was a 12-week open-label trial to test the feasibility, safety, tolerability and therapeutic effects of cannabidiol in reducing anxiety severity in young people.

The 30 participants recruited to the trial:

• were clients of Orygen’s primary care services
• were aged between 12 and 25 years (inclusive)
• had a diagnosed anxiety disorder
• had failed to show significant improvement in anxiety severity after five cognitive behavioural therapy (CBT) sessions that calendar year.

Participants started on a dose of one 200mg capsule of cannabidiol per day, which was increased to 400mg after one week. Those who did not show significant improvement in anxiety symptoms had their dosage increased at 200mg increments up to 800mg per day.

All participants were offered biweekly cognitive behavioural therapy (CBT) for 12 weeks (five sessions).

Why run the pilot study?

• Anxiety is the most common mental health condition in young people and affects up to 31.5 per cent of the Australian population.(10)
• Treatments for anxiety disorders include CBT and medications that increase serotonin levels in the brain but they do not work for everyone.
• In fact, only about 50 per cent of young people fully recover from anxiety disorders with current treatments.(1, 2) The remainder continue to experience symptoms that interfere with their life, work and education.
• Cannabidiol has been tested in healthy research participants and adults with anxiety disorder. In these studies cannabidiol has been found to reduce anxiety.(3, 4, 5, 6) The purpose of Orygen’s pilot study was to test the feasibility, safety, tolerability and therapeutic effects of cannabidiol in reducing anxiety severity in young people.

What is anxiety?

Anxiety disorders are characterised by persistent feelings of being anxious, that may have no obvious reason or cause. For people who suffer from anxiety, these feelings can be difficult to control. Although feeling anxious is a common response to a situation where we feel under pressure, if such feelings persist or occur suddenly in the absence of a stimulus, this can be quite disabling and may require support or treatment.

What does it mean to have anxiety?

Although some people may experience only mild anxiety, more severe anxiety often interferes with people’s lives and can be associated with palpitations (pounding heart or accelerated heart rate), panic, feeling detached from oneself, sweating, trembling, shortness of breath or chest pain.

How common is anxiety?

Anxiety is the most common mental health condition in young people and affects up to 31.5 per cent of the Australian population.(10)

References

1. James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane database of systematic reviews (Online); 2015. p. CD004690.
2. Strawn JR, Welge JA, Wehry AM, Keenshin B, Rynn MA. Efficacy and tolerability of antidepressants in pediatric anxiety disorders: a systematic review and meta-analysis. Depress Anxiety; 2015. p. 149-57.
3. Bergamaschi MM, Queiroz RHC, Chagas MHN, et al. Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Na&amp;iuml;ve Social Phobia Patients. Neuropsychopharmacology: Nature Publishing Group; 2011. p. 1219-26.
4. Zuardi AW, Cosme RA, Graeff FG, Guimarães FS. Effects of ipsapirone and cannabidiol on human experimental anxiety. J Psychopharmacol (Oxford); 1993. p. 82-8.
5. Crippa JAdS, Zuardi AW, Garrido GEJ, et al. Effects of cannabidiol (CBD) on regional cerebral blood flow.  Neuropsychopharmacology; 2004. p. 417-26.
6. Crippa JAS, Derenusson GN, Ferrari TB, et al. Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report.  J Psychopharmacol (Oxford); 2011. p. 121-30.
7. Therapeutic Goods Administration. Prescription medicines: registration of new chemical entities in Australia, September 2020. Available from: https://www.tga.gov.au/prescription-medicines-registration-new-chemical-entities-australia
8. Australian New Zealand Clinical Trials Registry. Trial Search: cannabidiol. 2022. Available from: https://anzctr.org.au/TrialSearch.aspx
9. Jutras-Aswad D, Prud’homme M, Cata R. Cannabidiol as an Intervention for Addictive Behaviors: A Systematic Review of the Evidence.  SART; 2015. p. 33.
10. AIHW. Mental health: prevalence and impact. 2022. Available from: https://www.aihw.gov.au/reports/mental-health-services/mental-health

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JOURNAL

Journal of Clinical Psychiatry

ARTICLE TITLE

Cannabidiol for treatment-resistant anxiety disorders in youth people: an open-label trial

Digital farm in Niger: An advanced system to adjust farmer's water usage

 In Niger, a Tech entrepreneur is hoping that his innovation in automatic irrigation could be a game changer for rural communities struggling to manage increasingly scarce water supplies. Abdou Maman Kane's prizewinning system lets farmers adjust their water usage drop by drop. Our team reports.

WHO urges caution after dog catches monkeypox

Issued on: 17/08/2022 - 

Geneva (AFP) – The World Health Organization called Wednesday for people infected with monkeypox to avoid exposing animals to the virus following a first reported case of human-to-dog transmission.

A first case of human-to-dog transmission of monkeypox -- between two men and their Italian greyhound living together in Paris -- was reported last week in the medical journal The Lancet.

"This is the first case reported of human-to-animal transmission... and we believe it is the first instance of a canine being infected," Rosamund Lewis, the WHO's technical lead for monkeypox, told reporters.

Experts had been aware of the theoretical risk that such a jump could happen, she said, adding that public health agencies had already been advising those suffering from the disease to "isolate from their pets".

She also said "waste management is critical" to lowering the risk of contaminating rodents and other animals outside the household.

Species barrier

When viruses jump the species barrier it often sparks concern that they could mutate dangerously.

Lewis stressed that so far there were no reports that was happening with monkeypox.

But she acknowledged that "as soon as the virus moves into a different setting in a different population, there is obviously a possibility that it will develop differently and mutate differently".

The main concern revolves around animals outside of the household.

"The more dangerous situation... is where a virus can move into a small mammal population with high density of animals," WHO emergencies director Michael Ryan told reporters.

"It is through the process of one animal infecting the next and the next and the next that you see rapid evolution of the virus."

He stressed though that there was little cause for concern around household pets.

"I don't expect the virus to evolve any more quickly in one single dog than in one single human," he said, adding that while "we need to remain vigilant... pets are not a risk."

Monkeypox was originally identified in monkeys kept for research in Denmark in 1958, though it is found most frequently in rodents.

The disease was first discovered in humans in 1970, with the spread since then mainly limited to certain West and Central African countries.

But in May, cases of the disease, which causes fever, muscular aches and large boil-like skin lesions, began spreading rapidly around the world, mainly among men who have sex with men.

Worldwide, more than 35,000 cases have been confirmed since the start of the year in 92 countries, and 12 people have died, according to the WHO, which has designated the outbreak a global health emergency.

'Not a silver bullet'

With global case numbers jumping by 20 percent in the past week alone, the UN health agency is urging all countries to do more to rein in the spread, including ensuring at-risk populations have access to services and information about the dangers and how to protect themselves.

There is also a vaccine, originally developed for smallpox, but it is in short supply.

Lewis also stressed that there was still little data on the effectiveness of the vaccine in protecting against monkeypox in the current outbreak.

While no randomised control trials had been conducted yet, she said there were reports of breakthrough cases following vaccination, indicating "the vaccine is not 100 percent".

Pointing to limited studies in the 1980s suggesting that the smallpox vaccines used at the time might offer 85-percent protection against monkeypox, she said the breakthrough cases were "not really a surprise".

"But it reminds us that the vaccine is not a silver bullet," she said.

© 2022 AFP

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