Helen L Richards

Mercy University Hospital, Corcaigh, Munster, Ireland

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Publications (69)208.97 Total impact

  • Dónal G. Fortune · Carol R. Rogan · Helen L. Richards ·
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    ABSTRACT: Objectives The purpose of this study was to examine whether a brief structured multicomponent group programme for carers of people with acquired brain injury (ABI) was effective in reducing carer distress, strain, and critical comments between carer and person with an ABI compared to a waiting list control condition.DesignWaiting list controlled study. Pre- and post-test design with outcomes measured at induction, at the end of the intervention, and at the 3-month follow-up.Methods One hundred and thirteen carers took part in the study: 75 carers in the intervention group and 38 in the waiting list control group (2:1 ratio). All participants completed assessments of caregiver strain (Caregiver Strain Index), perceived criticism towards and from the person with an ABI (Perceived Criticism Scale), and psychological distress (Hospital Anxiety and Depression Scale). The person with an ABI was also assessed on the Functional Independence Measure/Functional Assessment Measure.ResultsUsing an intention to treat analysis, there were significant effects of group (intervention vs. waiting list control) at the 3-month follow-up on carers' perceptions of stress and strain resulting from caring, and perceptions of criticism received by the carer from the person with an ABI. A subsequent per-protocol analysis showed an additional reduction at 3 months in levels of criticism expressed towards the person with an ABI by the carer. There was no significant effect of the intervention on psychological distress.Conclusions The structured multicomponent carers programme showed beneficial effects in terms of reducing carer strain and in the reduction of elements of perceived criticism at the 3-month follow-up; however, it did not significantly affect psychological distress in carers, suggesting the need for additional support for this group of carers.Statement of contribution What is already known on this subject? A number of studies have suggested that carers of people with acquired brain injury (ABI) experience greater levels of carer burden and mental health difficulties than carers of other patient groups. Previous interventional studies on ABI are few, and such studies have diverged in the extent to which they have been oriented towards education, psychological support, or management of behavioural difficulties, making results somewhat difficult to apply in community health settings with this potential client group. What does this study add? We develop, describe, and evaluate a brief structured multicomponent carers' training and support programme for carers of people with ABI.Not all outcomes were affected positively by the intervention. While the intervention successfully reduced carer strain and critical comments, distress did not significantly reduce compared to people in a waiting list control group.Carers who were spouses/partners and carers who were parents exhibited comparable levels of strain, distress, and perceived criticism.Younger carers reported significantly higher levels of distress and carer strain at induction to the programme.The positive effects of the programme were maintained for at least 3 months, suggesting that it may have initial validity for improving some of the negative aspects of the carer experience.
    British Journal of Health Psychology 08/2015; DOI:10.1111/bjhp.12159 · 2.70 Impact Factor
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    ABSTRACT: Objective: Cutaneous telangiectases are a characteristic and psychologically distressing feature of SSc. Our aim was to assess the efficacy of two light-based treatments: pulsed dye laser (PDL) and intense pulsed light (IPL). Methods: Nineteen patients with facial or upper limb telangiectases underwent three treatments with PDL and IPL (randomly assigned to left- and right-sided lesions). Outcome measures were clinical photography (assessed by two clinicians), dermoscopy (assessed by two observers), laser Doppler imaging (LDI) and observer and patient opinion, including patient self-assessment psychological questionnaires [Hospital Anxiety and Depression Scale (HADS), Adapted Satisfaction with Appearance Scale (ASWAP)]. Results: Comparison between 16-week follow-up and baseline photography scores (from -2 to +2 on a Likert scale, with >0 being improvement) were a mean score for PDL of 1.7 (95% CI 1.4, 2.0) and for IPL 1.4 (0.9, 1.8), with a mean difference between PDL and IPL of -0.3 (-0.5, -0.1) (P = 0.01). Dermoscopy scores also improved with both therapies: PDL 1.3 (1.1, 1.5) and IPL 0.8 (0.5, 1.1), again greater with PDL (P = 0.01). LDI showed decreases in blood flow at 16 weeks, indicating a response to both therapies. All patients reported benefit from treatment (more preferred PDL at 16 weeks). Psychological questionnaires also indicated improvement after therapy with mean change in ASWAP of -13.9 (95% CI -20.5, -7.4). No side effects were reported for IPL; PDL caused transient bruising in most cases. Conclusion: Both PDL and IPL are effective treatments for SSc-related telangiectases. Outcome measures indicate that PDL has better outcomes in terms of appearance, although IPL had fewer side effects.
    Rheumatology (Oxford, England) 03/2014; 53(8). DOI:10.1093/rheumatology/keu006 · 4.48 Impact Factor
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    ABSTRACT: Objectives: To determine the extent of body image dissatisfaction (BID) in patients with self-reported systemic sclerosis (SSc)-related telangiectases and to identify the demographic, psychological and disease-related correlates of BID within a cross-sectional study. Methods: Patients with SSc were invited to participate in a questionnaire survey. Each completed the Adjusted Satisfaction with Appearance Scale (ASWAP), the Hospital Anxiety and Depression Scale (HADS) and an open-ended telangiectases questionnaire. Thematic analysis was utilised to describe the qualitative data. Results: 141 patients with SSc participated (83% female, 70% limited cutaneous SSc, median age 62 years). Telangiectases were reported by 113 (80%). ASWAP 'dissatisfaction with appearance' scores were significantly higher in those reporting telangiectases (p=0.02). Anxiety and depression scores were similar in those with and without telangiectases. Those reporting telangiectases were more likely to be anticentromere positive (40% vs. 18%, p=0.02) and to have a history of severe digital ischaemia (38% vs. 18%, p=0.04) than those not. Qualitative analysis revealed four themes: changes in behaviour as a result of telangiectases, public and private self-image, negative emotional impact of telangiectases and appreciation of life. Conclusions: BID, as measured by the ASWAP 'dissatisfaction with appearance' subscale, was significantly higher in patients with telangiectases. Telangiectases were associated with anticentromere positivity and digital ischaemia, lending further support for telangiectases as a potential marker for vascular involvement. Qualitative analysis provided new insights into the thoughts and feelings of patients with telangiectases. Our findings highlight the impact of telangiectases and the need to address and manage related concerns.
    Clinical and experimental rheumatology 01/2013; 31(2 Suppl 76). · 2.72 Impact Factor
  • Muneeza Rizwan · Ann K Haylett · Helen L Richards · Tsui C Ling · Lesley E Rhodes ·
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    ABSTRACT: Abnormal cutaneous sensitivity to the ultraviolet and/or visible radiation in sunlight characterizes photosensitivity disorders. Little is known regarding their impact in childhood. Our objective was to characterize childhood photosensitivity disorders presenting to a photoinvestigation unit, evaluating their impact on quality of life (QoL). Photoinvestigation records of children attending from 2000 to 2007 were evaluated for diagnosis, clinical, demographic and phototest parameters. These children were subsequently contacted during summertime to evaluate the impact of photosensitivity on QoL, utilizing the children's dermatology life quality index (CDLQI). 83 children underwent photoinvestigation; 62 (74.7%) were diagnosed photosensitive (mean age 8.6 years, range 2-16; 33 female), with abnormal phototest findings in 35 children. 38/55 questionnaires (69.1%) were returned. Mean (± standard deviation) CDLQI score (all diagnoses) was 10.2 ± 7.3 with very high scores in xeroderma pigmentosum (20.7 ± 5.7; n = 3) and actinic prurigo (18.2 ± 7.1; n = 6) and moderate scores in photoaggravated eczema (7.9 ± 4.2; n = 8) and polymorphic light eruption (6.2 ± 4.4 n = 18). CDLQI correlated with number of months affected per year (r = 0.595, P = 0.001). Photosensitivity disorders have a substantial impact, ranging from moderate to extremely large, on QoL in childhood, and the psychological consequences should be considered in their management.
    Photodermatology Photoimmunology and Photomedicine 12/2012; 28(6):290-2. DOI:10.1111/j.1600-0781.2012.00691.x · 1.26 Impact Factor
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    ABSTRACT: Photodermatoses are a group of skin disorders caused or exacerbated by ultraviolet and/or visible radiation, which collectively affect a high proportion of the population and substantially affect quality of life (QoL). Our objective was to assess the psychological impact of these conditions. Patients with a range of photodermatoses diagnosed at a specialist investigation centre in the UK completed questionnaires evaluating (i) anxiety and (ii) depression, using the Hospital Anxiety and Depression Scale (HADS), (iii) social anxiety, using the Fear of Negative Evaluation measure (FNE), (iv) coping strategies (brief COPE) and (v) QoL, using the Dermatology Life Quality Index (DLQI). Questionnaires were returned by 185 of 260 patients (71.1% response rate). Mean age was 50.2 years (SD 14.5, range 20-85), 80.3% female. Polymorphic light eruption was the most common diagnosis, followed by photoaggravated eczema, other photoaggravated dermatological conditions and solar urticaria. Across the sample, high percentages, i.e. 23% and 7.9% of individuals, showed scores indicating clinical levels of anxiety and depression, respectively. Facial involvement was a strong indicator for depression (t = 2.7, p < 0.01). In regression analyses psychological factors (particularly depression and adaptive coping) were the principle predictors of QoL, accounting for 17.7% of the variance (F = 7.61, p < 0.01), while clinical variables accounted for an additional 10.1% (F = 8.96, p < 0.01), with number of months/year affected exerting a significant effect (p < 0.01). This study demonstrates the high psychological comorbidity of these conditions; more awareness of this is required, with adoption of a biopsychosocial approach to their management.
    Photochemical and Photobiological Sciences 09/2012; 12(1). DOI:10.1039/c2pp25177a · 2.27 Impact Factor
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    ABSTRACT: Telangiectases represent microvascular changes inherent in the systemic sclerosis (SSc) disease process. Intense pulsed light (IPL) is an effective treatment for non-SSc-related cutaneous telangiectases. This pilot study aimed to examine the efficacy, safety and tolerability of IPL treatment in an open study of patients with SSc. Patients underwent three treatments of IPL at monthly intervals and attended follow-up examinations at 1, 6 and 12 months after final treatment. Photographs, laser Doppler imaging (LDI) and thermography were used to measure changes at each visit. Seventeen patients completed the study. Photographs were graded (compared with baseline) as: at 1-month follow-up, four 'no change', four 'improved' and eight 'much improved'; at 6-month follow-up, four 'no change', eight 'improved'; and four 'much improved'; and at 12-month follow-up (eight images were available), three 'no change', two 'improved' and three 'much improved'. Perfusion as measured by LDI (perfusion units) was significantly reduced, compared with baseline [median 2·66, interquartile range (1·78-3·93)], at 1 month [1·70 (1·07-2·55), P = 0·006] and 6 months [2·05 (1·42-2·36), P = 0·008] post-treatment, but not at 12 months [1·61 (1·14-3·22), P =0·088]. No differences were found in skin temperature between baseline and follow-up visits. In this pilot study (the first of IPL treatment for SSc-related telangiectases) most patients improved after IPL treatment. However, the degree of improvement was not maintained in all patients at 6-12 months, suggesting that further treatments may be necessary. Longer term studies of this novel treatment approach are now required.
    British Journal of Dermatology 04/2012; 167(3):563-9. DOI:10.1111/j.1365-2133.2012.11019.x · 4.28 Impact Factor
  • Holly Ennis · Ariane L Herrick · Eileen M Baildam · Helen L Richards ·

    Rheumatology (Oxford, England) 04/2012; 51(7):1331-3. DOI:10.1093/rheumatology/kes071 · 4.48 Impact Factor
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    Rheumatology 02/2012; 51(suppl 2):ii5-ii6. DOI:10.1093/rheumatology/ker472 · 4.48 Impact Factor
  • Laura Sahm · Lisa Quinn · Michael Madden · Helen L Richards ·
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    ABSTRACT: This study examined how satisfaction with information about warfarin related to demographic and clinical factors including therapeutic outcome. This study took place in the Outpatient clinic of the Mercy University Hospital, Cork, Rep. of Ireland. Patients attending an anticoagulation clinic completed the Satisfaction with Information about Medicines (SIMS) Scale. This was examined in line with clinical and demographic information including: age, gender, diagnosis, number of weeks taking warfarin, and INR control. The level of satisfaction with information was measured and in addition the association between anticoagulation control and satisfaction level was examined. One hundred and nineteen patients (61.3% male), participated in the study. The majority of patients were prescribed warfarin for atrial fibrillation (53.8%). Satisfaction with information about warfarin was inversely related to age (ρ = -0.33, P < 0.01). Patient-reported satisfaction with information pertaining to the question "what is your medicine for?" was significantly associated with anticoagulation control (χ(2) = 7.27, P < 0.01).
    03/2011; 33(3):543-8. DOI:10.1007/s11096-011-9505-2
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    ABSTRACT: there have been few studies of quality of life in childhood scleroderma and these focused predominantly on self-perception and the influence of skin lesions. Our cross-sectional study aimed to describe the influence of childhood scleroderma on physical function and quality of life in relation to clinical and demographic measures. children with either localized scleroderma or systemic sclerosis (SSc) attending pediatric rheumatology clinics, together with their parents or guardians, were asked to complete a set of 4 validated measures. Clinical and demographic data were provided by consultant pediatric rheumatologists. in total, 28 children and their parents/guardians participated in the study (68% female, median age 13 yrs; 86% localized scleroderma, 14% SSc). The median Child Health Assessment Questionnaire (CHAQ) score was 0.1 (range 0-3, 0 indicating no impairment), the median Child Dermatology Life Quality Index (CDLQI) score was 5 (range 0-30, 0 indicating no impairment), and the median Child Quality of Life Questionnaire (CQOL) function score was 26 (range 0-105, 0 indicating no impairment). Family activity, measured by the Child Health Questionnaire (CHQ-PF50), was also moderately impaired by scleroderma, with a median score of 83 (0-100, 100 indicating no impairment). scleroderma had only a moderate effect on quality of life and physical function as measured by the 4 validated instruments. Although a small number of children reported greater impairment, this is an encouraging finding, given its potential disfiguring and debilitating effects.
    The Journal of Rheumatology 11/2010; 38(1):167-73. DOI:10.3899/jrheum.100447 · 3.19 Impact Factor
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    ABSTRACT: Of the 131 studies on monotherapy or combination therapy assessed, 56 studies on the different forms of phototherapy fulfilled the criteria for inclusion in the guidelines. Approximately three-quarters of all patients treated with phototherapy attained at least a PASI 75 response after 4 to 6 weeks, and clearance was frequently achieved (levels of evidence 2 and 3). Phototherapy represents a safe and very effective treatment option for moderate to severe forms of psoriasis vulgaris. The onset of clinical effects occurs within 2 weeks. Of the unwanted side effects, UV erythema from overexposure is by far the most common and is observed frequently. With repeated or long-term use, the consequences of high, cumulative UV doses (such as premature aging of the skin) must be taken into consideration. In addition, carcinogenic risk is associated with oral PUVA and is probable for local PUVA and UVB. The practicability of the therapy is limited by spatial, financial, human, and time constraints on the part of the physician, as well as by the amount of time required by the patient. From the perspective of the cost-bearing institution, phototherapy has a good cost-benefit ratio. However, the potentially significant costs for, and time required of, the patient must be considered.
    Journal of the European Academy of Dermatology and Venereology 11/2009; 23 Suppl 2(s2):1-70. DOI:10.1111/j.1468-3083.2009.03389.x · 2.83 Impact Factor
  • Laura Sahm · Aoife MacCurtain · John Hayden · Cicely Roche · Helen L Richards ·
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    ABSTRACT: Low levels of adherence to medication are commonly reported in chronic medical conditions. Empirical evidence suggests that patients are willing to accept pharmacist interventions to improve adherence. This study aimed to assess the levels of self-reported adherence to antidepressant medication in the community and to investigate the acceptability of text message reminders to self-reported unintentional non-adherers. Community pharmacy in Wexford; Republic of Ireland. A structured questionnaire was administered to patients who were collecting antidepressant medication, which had been prescribed for at least 6 months. Of the 59 patients who completed the study, 54% reported that they were unintentionally non-adherent. This group tended to be younger in age (t = -2.50, P = 0.02). Fifty-nine percent of the unintentional non-adherers were willing to receive a prompt such as a text message from the pharmacy to remind them to take their medication. There was no association between gender or age and acceptability of text message reminders. Unintentional non-adherence to antidepressant medication exceeded 50% in this population. Electronic reminders, in this case text messages, were acceptable to approximately 60% of patients who reported being unintentionally non-adherent. Reasons for refusal of electronic reminders should be investigated as this will affect the applicability of this intervention.
    International Journal of Clinical Pharmacy 10/2009; 31(6):627-9. DOI:10.1007/s11096-009-9327-7 · 0.92 Impact Factor
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    ABSTRACT: Psoriasis produces significant psychosocial disability; however, little is understood about the neurocognitive mechanisms that mediate the adverse consequences of the social stigma associated with visible skin lesions, such as disgusted facial expressions of others. Both the feeling of disgust and the observation of disgust in others are known to activate the insula cortex. We investigated whether the social impact of psoriasis is associated with altered cognitive processing of disgust using (i) a covert recognition of faces task conducted using functional magnetic resonance imaging (fMRI) and (ii) the facial expression recognition task (FERT), a decision-making task, conducted outside the scanner to assess the ability to recognize overtly different intensities of disgust. Thirteen right-handed male patients with psoriasis and 13 age-matched male controls were included. In the fMRI study, psoriasis patients had significantly (P<0.005) smaller signal responses to disgusted faces in the bilateral insular cortex compared with healthy controls. These data were corroborated by FERT, in that patients were less able than controls to identify all intensities of disgust tested. We hypothesize that patients with psoriasis, in this case male patients, develop a coping mechanism to protect them from stressful emotional responses by blocking the processing of disgusted facial expressions.Abbreviations: BOLD, blood oxygenation level-dependent; 95% CI, 95% confidence interval; FERT, facial expression recognition task; fMRI, functional magnetic resonance imaging; HADS, Hospital Anxiety and Depression Scale; OR, odds ratio; PASI, Psoriasis Area and Severity Index; VAS, visual analog scale
    Journal of Investigative Dermatology 08/2009; 129(11):2613-2619. DOI:10.1038/jid.2009.152 · 7.22 Impact Factor
  • H L Richards · T C Ling · G Evangelou · R C C Brooke · D G Fortune · L E Rhodes ·
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    ABSTRACT: Polymorphic light eruption (PLE) is a prevalent photosensitivity condition associated with psychological distress. Objective To examine patients with PLE for evidence of anxiety and depression, the influence of demographic and clinical variables, and the coping strategies used. In a cross-sectional design, patients with PLE (n = 145) who had attended a hospital dermatology department completed validated questionnaires assessing anxiety, depression, social anxiety, and coping strategies. Clinical variables examined were: (i) number of months of the year affected by PLE; (ii) facial involvement; (iii) time taken for the rash to resolve; and (iv) whether the patient ever used steroids for their condition. Participants ranged in age from 16-78 (mean 44 years, SD 11.9), 81% female, with a mean age at onset of PLE of 28 years. Evidence of high levels of anxiety and depression was found in PLE, with 22% and 8% of patients scoring as probable cases for anxiety and depression, respectively. Higher levels of anxiety were associated with younger age of onset of PLE (r = -0.25, P < 0.01) and facial involvement (t = 2.84, P < 0.01), and depression was also associated with facial involvement (t = 3.60, P < 0.01). Furthermore, higher levels of depression and anxiety were associated with the use of maladaptive coping strategies, and depression was found to be the principal predictor of quality of life. High levels of anxiety and depression occur in PLE. Clinicians should be alert to the potential need for psychological management, particularly in patients with facial involvement and a younger age of onset of PLE.
    British Journal of Dermatology 06/2008; 159(2):439-44. DOI:10.1111/j.1365-2133.2008.08623.x · 4.28 Impact Factor
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    Anja Wittkowski · Helen L Richards · Jennifer Williams · Chris J Main ·
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    ABSTRACT: The objective of this study was to examine the psychometric properties of the revised Illness Perceptions Questionnaire (IPQ-R) in adult participants with atopic dermatitis (AD). Two hundred and eighty-four participants who had a GP or dermatologist confirmed diagnosis of AD completed the IPQ-R. The factor structure of the IPQ-R was examined using confirmatory (CFA) and exploratory factor analysis (EFA). The results of the CFA did not indicate a good comparative fit with the IPQ-R subscales, while the EFA and a fixed six-factor principal components analysis largely replicated the original factor structure of the IPQ-R. The existence of the acute/chronic and cyclical timeline dimensions, and the illness coherence subscale was most strongly supported, while all items of the consequences and emotional representation subscales consistently loaded onto one factor. The EFA for causal attributions did not produce a stable solution. The findings indicate that although the factor structure of the IPQ-R was not confirmed in the sample of patients with AD using CFA, it was partly reproduced using EFA. Overall, the results suggest that in patients with AD the IPQ-R, in particular the consequences and emotional representations subscales, should be employed and interpreted with care.
    Psychology Health and Medicine 06/2008; 13(3):346-59. DOI:10.1080/13548500701487697 · 1.26 Impact Factor
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    ABSTRACT: Psychological stress is believed to exacerbate inflammatory skin disease but the underlying mechanisms are poorly understood. We investigated the impact of acute social stress--Trier public speaking test--on: epidermal Langerhans' cell (LC) frequency; and cutaneous nerve fiber expression of protein gene product (PGP) 9.5 and calcitonin gene-related peptide (CGRP). Thirty-six healthy volunteers each had a pair of baseline 6 mm biopsies taken from sun-protected buttock skin. A second pair of biopsies was taken from contralateral buttock 4 hours (n=5) or 24 hours (n=15) after the Trier stressor. Controls (n=16) did not perform the Trier and had biopsies 24 hours apart. One of each pair of biopsies (baseline; 4 or 24 hours) was processed for counts of epidermal CD1a(+) LC; the other examined for PGP 9.5 and CGRP expression. We observed a significant (P<0.01) 16.4% reduction in epidermal LC frequency 24 hours post-stressor as compared with baseline; there was no significant change from baseline in non-stressed controls. At 24 hours, PGP 9.5 and CGRP were increased (P=0.025) and reduced (P=0.03), respectively, from baseline in the stressed group compared with controls. These data suggest that acute social stress reduces epidermal LC frequency and modulates cutaneous neuropeptide expression thereby supporting the concept of a "brain-skin" axis.
    Journal of Investigative Dermatology 05/2008; 128(5):1273-9. DOI:10.1038/sj.jid.5701144 · 7.22 Impact Factor
  • H.L. Richards · D.G. Fortune · C.E.M. Griffiths ·

    British Journal of Dermatology 02/2008; 158(1):176-8. DOI:10.1111/j.1365-2133.2007.08247.x · 4.28 Impact Factor
  • B Kirby · H.L. Richards · D.L. Mason · D.G. Fortune · C.J. Main · C.E.M. Griffiths ·
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    ABSTRACT: Psoriasis has been associated with excessive alcohol consumption and psychological distress. To investigate the level of alcohol use in a psoriasis population and to determine whether alcohol consumption is linked to psychological distress in patients with psoriasis. Ninety-five patients with chronic plaque psoriasis completed validated questionnaires designed to assess psychological distress, current and past alcohol consumption and self-reported physical severity of psoriasis. Using different measures of alcohol consumption, between 17% and 30% of patients were classified as having difficulties with alcohol. Thirteen per cent and 18% of patients with psoriasis believed that they had a current or past drinking problem, respectively. There was a modest but significant association between levels of anxiety and depression and weekly alcohol consumption (r = 0.29, P < 0.01 and r = 0.24, P = 0.03, respectively). Those patients who believed that they had an alcohol problem had higher levels of anxiety (P = 0.03), depression (P < 0.01) and psoriasis-associated disability (P = 0.04). There was a modest but significant association between physical severity of psoriasis and weekly alcohol consumption (r = 0.27, P = 0.02). A significant minority of patients with psoriasis consumes excessive alcohol. Patients with psoriasis should be assessed for excessive alcohol use and appropriate interventions initiated. Further studies are required to investigate whether such interventions are effective in combating alcohol abuse and in improving the psychological and physical aspects of psoriasis.
    British Journal of Dermatology 01/2008; 158(1):138-40. DOI:10.1111/j.1365-2133.2007.08299.x · 4.28 Impact Factor
  • Anja Wittkowski · Richards H. L. · Griffiths C. E. M. · Main C. J. ·

    The Division of Clinical Psychology Annual Conference, London; 12/2007

  • The Division of Clinical Psychology Annual Conference, London; 12/2007

Publication Stats

3k Citations
208.97 Total Impact Points


  • 2008-2014
    • Mercy University Hospital
      Corcaigh, Munster, Ireland
  • 1998-2013
    • The University of Manchester
      • • School of Psychological Sciences
      • • Centre for Dermatology
      Manchester, England, United Kingdom
  • 2001-2005
    • Salford Royal NHS Foundation Trust
      Salford, England, United Kingdom
  • 2000-2004
    • UK society for behavioural medicine
      Salford, England, United Kingdom