Does message framing affect changes in behavioural intentions in people with psoriasis? A randomized exploratory study examining health risk communication.

Message framing is important in health communication research to encourage behaviour change. Psoriasis, a long-term inflammatory skin condition, has additional comorbidities including high levels of anxiety and cardiovascular disease (CVD), making message framing particularly important. This experimental study aimed to: (1) identify whether health messages about psoriasis presented as either gain- or loss-framed were more effective for prompting changes in behavioural intentions (BI), (2) examine whether BI were driven by a desire to improve psoriasis or reduce CVD risk; (3) examine emotional reactions to message frame; and (4) examine predictors of BI. A two by two experiment examined the effects on BI of message frame (loss vs. gain) and message focus (psoriasis symptom reduction vs. CVD risk reduction). Participants with psoriasis (n = 217) were randomly allocated to one of four evidence-based health messages related to either smoking, alcohol, diet or physical activity, using an online questionnaire. BI was the primary outcome. Analysis of variance tests and hierarchical multiple regression analyses were conducted. A significant frame by focus interaction was found for BI to reduce alcohol intake (p = .023); loss-framed messages were more effective for CVD risk reduction information, whilst gain-framed messages were more effective for psoriasis symptom reduction information. Message framing effects were not found for BI for increased physical activity and improving diet. High CVD risk was a significant predictor  of increased BI for both alcohol reduction (ß = .290, p < .01) and increased physical activity (ß = -.231, p < .001). Message framing may be an important factor to consider depending on the health benefit emphasised (disease symptom reduction or CVD risk reduction) and patient-stated priorities. Condition-specific health messages in psoriasis populations may increase the likelihood of message effectiveness for alcohol reduction.

'New to me': changing patient understanding of psoriasis and identifying mechanisms of change. The Pso Well® patient materials mixed-methods feasibility study.

BACKGROUND: Psoriasis is an inflammatory long-term condition involving comorbidities, unhealthy lifestyle and significant life impact. Patients' understanding of psoriasis is limited and support lacking. The Common-Sense Model of Self-Regulation of Health and Illness emphasizes the role of illness and treatment beliefs on coping and self-management. New 'Pso Well® ' patient materials informed by the model, addressed psoriasis as a long-term condition, medication management and lifestyle behaviours. OBJECTIVES: To investigate whether Pso Well® materials (i) broaden understanding of psoriasis without increasing anxiety; (ii) are acceptable; and (iii) comprise features that appear to effect change. METHODS: The Revised Illness Perceptions Questionnaire (IPQ-R modified) and the Hospital Anxiety and Depression Scale (HADS) were administered in patients before and after intervention. Numerical rating scales assessed perceptions of change in understanding and anxiety resulting from engagement with the materials. Qualitative interviews explored acceptability and perceived 'active ingredients'. RESULTS: Fifty-five patients completed pre- and postintervention questionnaires (56% female; median age 59 years). Postintervention, a large effect size was indicated in two IPQ-R domains - illness coherence [t(55) = -3·48, P = 0·001 (two-tailed), η2  = 0·19] and personal control [t(55) = -2·98, P = 0·004 (two-tailed), η2  = 0·14] - and a medium effect in one, treatment control [t(55) = -2·08, P = 0·042 (two-tailed), η2  = 0·08]. HADS scores did not change. For numerical rating scales, 80% of participants reported increased understanding of psoriasis and none reported increased anxiety. Interviews with 19 patients indicated the materials were acceptable and usable. Factors reported to broaden understanding and promote engagement with self-management included linking of related disease aspects, personally relevant content and high-quality design. CONCLUSIONS: High-quality, theory-based psoriasis materials are acceptable to patients and can improve understanding and sense of control without increasing anxiety.

Motivational interviewing-based training enhances clinicians' skills and knowledge in psoriasis: findings from the Pso Well® study.

BACKGROUND: Psoriasis is a common long-term, immune-mediated skin condition associated with behavioural factors (e.g. smoking, excess alcohol, obesity), which increase the risk of psoriasis onset, flares and comorbidities. Motivational interviewing (MI) is an evidence-based approach to health-related behaviour change that has been used successfully for patients with long-term conditions. This study assessed change in clinicians' MI skills and psoriasis knowledge following Psoriasis and Wellbeing (Pso Well® ) training. OBJECTIVES: To investigate whether the Pso Well training intervention improves clinicians' MI skills and knowledge about psoriasis-related comorbidities and risk factors; and to explore the acceptability and feasibility of the Pso Well training content, delivery and evaluation. METHODS: Clinicians attended the 1-day training programme focused on MI skills development in the context of psoriasis. MI skills were assessed pre- and post-training using the Behaviour Change Counselling Index. Knowledge about psoriasis-related comorbidity and risk factors was assessed with a novel 22-point measure developed for the study. Interviews with clinicians were analysed qualitatively to identify perceptions about the feasibility and acceptability of the training. RESULTS: Sixty-one clinicians completed the training (35 dermatology nurses, 23 dermatologists and three primary-care clinicians). Clinicians' MI skills (P < 0·001) and knowledge (P < 0·001) increased significantly post-training. Clinicians found the training valuable and relevant to psoriasis management. CONCLUSIONS: Attendance at the Pso Well training resulted in improvements in clinicians' knowledge and skills to manage psoriasis holistically. Clinicians deemed the training itself and the assessment procedures used both feasible and acceptable. Future research should investigate how this training may influence patient outcomes.

Expanding marine protected areas to include degraded coral reefs.

Marine protected areas (MPAs) are a commonly applied solution to coral reef degradation, yet coral reefs continue to decline worldwide. We argue that expanding the range of MPAs to include degraded reefs (DR-MPA) could help reverse this trend. This approach requires new ecological criteria for MPA design, siting, and management. Rather than focusing solely on preserving healthy reefs, our approach focuses on the potential for biodiversity recovery and renewal of ecosystem services. The new criteria would help identify sites with the highest potential for recovery and the greatest resistance to future threats (e.g., increased temperature and acidification) and sites that contribute to MPA connectivity. The DR-MPA approach is a compliment rather than a substitute for traditional MPA design approaches. We believe that the DR-MPA approach can enhance the natural, or restoration-assisted, recovery of DRs and their ecosystem services; increase total reef area available for protection; promote more resilient and better-connected MPA networks; and improve conditions for human communities dependent on MPA ecosystem services.

'In someone's clinic but not in mine'--clinicians' views of supporting lifestyle behaviour change in patients with psoriasis: a qualitative interview study.

BACKGROUND: Psoriasis is associated with significant comorbidity. Excess alcohol use, smoking and higher body mass index are all associated with psoriasis and may contribute to its onset and/or exacerbation. Lifestyle behaviour change (LBC) can be beneficial in the prevention of psoriasis and/or reduction of its severity. LBC techniques are effective when used properly by healthcare professionals. OBJECTIVES: It is unknown whether clinicians managing patients with psoriasis are familiar with LBC techniques or are confident to deliver LBC support in routine consultations. This study aimed to elicit the views and attitudes of healthcare professionals in primary and secondary care about addressing LBC for patients with psoriasis. METHODS: We carried out in-depth semistructured interviews with 23 dermatology specialist and general practitioners in English primary and secondary care settings stratified by discipline. Data were analysed using constant comparison and principles of Framework Analysis. RESULTS: Clinicians recognized that lifestyle behaviours were important in psoriasis management, but believed it was not their role to facilitate LBC. Limited knowledge and skills to implement LBC principles and techniques underpinned their beliefs. Participants identified a need for training to enable the incorporation of LBC support activity into psoriasis services. CONCLUSIONS: Clinicians are not yet trained to support patients with psoriasis with effective LBC methods. Training in these methods is needed to enable healthcare professionals to assess and manage psoriasis better.

Providing lifestyle behaviour change support for patients with psoriasis: an assessment of the existing training competencies across medical and nursing health professionals.

BACKGROUND: Psoriasis is associated with unhealthy lifestyle behaviours which contribute to psoriasis onset and severity. Health professionals who manage patients with psoriasis are well placed to support lifestyle change but few feel confident to do so. Little is known about the extent to which health promotion and lifestyle behaviour change (LBC) skills are included within post-qualification training curricula. OBJECTIVES: This study aimed to systematically examine the content of post-qualification U.K. training curricula for health professionals across General Practice and Dermatology for evidence of behaviour change skills relating to the promotion of healthy lifestyles. METHODS: Core curricula documents from professional organizations were analysed for content to examine the extent to which curricula: (1) mentioned health promotion and LBC as part of the professional role; and/or (2) included health promotion and LBC as explicit training competencies or requirements for qualification. RESULTS: Of the 11 core curricula documents analysed, we found 67 occurrences of terms related to LBC and health promotion. Most were in the General Practitioner curriculum (n = 42; 62·7%), followed by the Dermatology Specialist Nurse curriculum (n = 14; 20·9%) and Dermatologist curriculum (n = 11; 16·4%). No occurrences were found in the General Practitioner with a Special Interest in Dermatology curriculum. LBC knowledge, skills and attitudes were not clearly specified and only basic level LBC competencies were included. CONCLUSIONS: Development of post-qualification curricula would ensure health professionals are equipped with the necessary knowledge, skills and attitudes to support LBC for patients with psoriasis. This is of particular relevance, given the evidence linking unhealthy lifestyles with psoriasis outcomes.

Recognition of need in health care consultations: a qualitative study of people with psoriasis.

BACKGROUND: Psoriasis is a life-long inflammatory condition that can impact on quality of life, psychological and social functioning. Previous literature suggests patient dissatisfaction with psoriasis management; however, little is known about people's specific experiences of health care consultations. OBJECTIVES: The study aimed to explore in depth the perspectives of people living with psoriasis including coping responses, self-care strategies and how consultations with health care professionals in both primary and secondary care are experienced. METHODS: Qualitative semistructured interviews were carried out with a diverse sample of 29 people with psoriasis generated purposively and recruited from community sources in North West England. Interviews were coded using Framework Analysis to produce a thematic framework incorporating key emerging issues and concepts. RESULTS: Participants experienced psoriasis as a complex condition involving physical, psychological and social challenges, as well as issues of control, but perceived that these were largely unacknowledged by practitioners in health care consultations. Practitioners were perceived as lacking knowledge and expertise in the management of psoriasis, lacking empathy with the effects of psoriasis and failing to manage it as a long-term condition. This perceived lack of support resulted in some participants withdrawing from conventional health service providers and seeking alternative sources of help. CONCLUSIONS: Psoriasis needs to be recognized and managed as a complex long-term condition with emotional and social needs that are addressed alongside appropriate diagnosis and regular reviews of treatments which may involve referrals to specialist care.

Sound reproduction systems using variable-directivity loudspeakers.

Sound reproduction systems using omnidirectional loudspeakers produce reflections from room surfaces which interfere with the desired sound field within the array. While active compensation systems can reduce the reverberant level, they require calibration in each room and are processor-intensive. Directional loudspeakers allow the direct to reverberant level to be improved within the array, but still produce a finite exterior field which reflects from the room surfaces. The use of variable-directivity loudspeakers allows the exterior field to be eliminated at low frequencies by implementing the Kirchhoff-Helmholtz integral equation. This paper investigates the performance of variable-directivity arrays in reducing reverberant levels and compares the results with those derived in a previous paper for fixed-directivity arrays. The results presented may have some impact on the design of commercial multi-channel systems for sound reproduction.

Sound-field reproduction systems using fixed-directivity loudspeakers.

Sound reproduction systems using open arrays of loudspeakers in rooms suffer from degradations due to room reflections. These reflections can be reduced using pre-compensation of the loudspeaker signals, but this requires calibration of the array in the room, and is processor-intensive. This paper examines 3D sound reproduction systems using spherical arrays of fixed-directivity loudspeakers which reduce the sound field radiated outside the array. A generalized form of the simple source formulation and a mode-matching solution are derived for the required loudspeaker weights. The exterior field is derived and expressions for the exterior power and direct to reverberant ratio are derived. The theoretical results and simulations confirm that minimum interference occurs for loudspeakers which have hyper-cardioid polar responses.

Errors in two-point sound reproduction.

This paper deals with the problem of reproducing two signals at two points in space by using two acoustic sources. While much is now known about the techniques available for the design of matrices of inverse filters that enable this objective to be achieved in practice, it is still the basic physics of the sound field produced that controls the effectiveness of such systems and which ultimately dictates their design. The basic physical processes involved in producing the cross-talk cancellation that enables the reproduction of the desired signals is revisited here by using a simple two source/two field point free field model. The singular value decomposition is used to identify those frequencies where the inversion problem becomes ill-conditioned and to explain physically the origin of the ill-conditioning. As observed previously, it is found that cross-talk cancellation becomes problematic when the path length difference between the two sources and one of the field points becomes equal to one half the acoustic wavelength. The ill-conditioned frequencies are also found to be associated with a limited spatial region of cross-talk cancellation and with large source outputs manifested in the time domain by responses of long duration.

Antipsychotic drug treatment alters expression of mRNAs encoding lipid metabolism-related proteins.

Using an automated PCR-based genomics approach, TOtal Gene expression Analysis (TOGA), we have examined gene expression profiles of mouse striatum and frontal cortex in response to clozapine and haloperidol drug treatment. Of 17 315 mRNAs observed, TOGA identified several groups of related molecules that were regulated by drug treatment. The expression of some genes encoding proteins involved in neurotransmission, signal transduction, oxidative stress, cell adhesion, apoptosis and proteolysis were altered in the brains of both clozapine- and haloperidol-treated mice as recognized by TOGA. Most notable was the differential expression of those genes whose products are associated with lipid metabolism. These include apolipoprotein D (apoD), the mouse homolog of oxysterol-binding protein-like protein 8 (OSBPL8), a diacylglycerol receptor (n-chimerin), and lysophosphatidic acid (LPA) acyltransferase. Real-time PCR analysis confirmed increases in the RNA expression of apoD (1.6-2.2-fold) and OSBPL8 (1.7-2.6-fold), and decreases in the RNA expression of n-chimerin (1.5-2.2-fold) and LPA acyltransferase (1.5-fold) in response to haloperidol and/or clozapine treatment. Additional molecules related to calcium homeostasis and signal transduction, as well as four sequences of previously unidentified mRNAs, were also confirmed by real-time PCR to be regulated by drug treatment. While antipsychotic drugs may affect several metabolic pathways, lipid metabolism/signaling pathways may be of particular importance in the mechanisms of antipsychotic drug action and in the pathophysiology of psychiatric disorders.