***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment . Methods Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy ( UVB ) or photochemotherapy ( PUVA )  were r and omly assigned to one of two conditions : a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments , or a control condition consisting of the light treatments alone with no taped instructions .  Psoriasis status was assessed in three ways : direct inspection by unblinded clinic nurses ; direct inspection by physicians blinded to the patient 's study condition ( tape or no-tape ) ; and blinded physician evaluation of photographs of psoriasis lesions . Four sequential indicators of skin status were monitored during the study : a First Response Point , a Turning Point , a Halfway Point , and a Clearing Point . Results Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point ( p = .013 ) and the Clearing Point ( p = .033 ) significantly more rapidly than those in the no-tape condition , for both UVB and PUVA treatments . Conclusions A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis Psoriasis is a chronic inflammatory skin disease with important socioeconomic consequences . Data on psoriasis prevalence in Greece is scarce and circumstantially reported . The aim of this study was the recording of psoriatic patients ' demographic data , clinical characteristics of the disease , and exacerbating factors .  Seven hundred and eighty four patients were enrolled in 6 centres ( 4 in Athens and 2 in Thessaloniki ) in a multicenter epidemiologic prospect i ve study . The mean age of patients was 43.2 ( st and ard deviation , SD 17.44 ) years ( median 42 years ) , while the men : women ratio was 1.8:1 . Additionally , 35 % of patients reported a positive family history of psoriasis . The mean age of patients at the first episode of psoriasis was 31.3 ( SD 16.39 ) years ( median 28 years ) . Psoriasis vulgaris was the most common form of psoriasis in the population participating in this study . Flares of psoriasis occurred 2.6 times per year on average . The patients considered stress as the main cause for psoriasis exacerbation . Most frequent target points of psoriasis included elbows , legs , scalp and knees . The most common symptoms reported were scaling , and itching . On average , patients visited dermatologists 2.4 times per year for issues related to psoriasis . This study provides epidemiological information regarding psoriasis in Greece . Results of this survey could assist in delineation of patient profiles , and improve communication between doctors and patients OBJECTIVES To study the clinical spectrum of psoriasis and the incidence in the general population and to identify risk factors associated with the occurrence of psoriasis . DESIGN Prospect i ve cohort study with nested case-control analysis . SETTING The data source was the United Kingdom General Practice Research Data base containing computerized clinical information entered by general practitioners ( GPs ) . PATIENTS The study population comprised patients receiving a first-ever diagnosis of psoriasis between January 1 , 1996 , and December 31 , 1997 , and free of cancer . INTERVENTIONS Diagnosis of psoriasis was vali date d in a r and om sample of 14 % of all ascertained cases requesting confirmation by the GPs . Nested case-control analysis included 3994 cases of psoriasis and a r and om sample of 10 000 controls frequency matched to cases by age , sex , and calendar year . MAIN OUTCOME MEASURES Incidence rate of psoriasis and estimates of the odds ratio ( OR ) and 95 % confidence interval ( CI ) for psoriasis as associated with selected risk factors . RESULTS The incidence rate of psoriasis was 14 per 10 000 person-years . Patients with antecedents of skin disorders and skin infection within the last year carried the highest risk of developing psoriasis ( OR , 3.6 [ 95 % CI , 3.2 - 4.1 ] , and OR , 2.1 [ 95 % CI , 1.8 - 2.4 ] , respectively ) . Also , smoking was found to be an independent risk factors for psoriasis ( OR , 1.4 [ 95 % CI , 1.3 - 1.6 ] ) . We did not find an association between risk of psoriasis and antecedents of stress , diabetes , hypertension , hyperlipidemia , cardiovascular disease , or rheumatoid arthritis . CONCLUSIONS The incidence rate in our study was higher than those published in other studies , probably owing to our case definition that considered cases recorded by the GPs independently of a specialist confirmation . Our results confirm the association between psoriasis , skin disorders , and smoking Ro 10 - 9359 is a retinoic acid derivative , selected for study because of a better tolerance than retinoic acid , shown in animal experiments . Doses of 25 mg b.i.d . , 25 mg t.i.d . and 50 mg b.i.d . were administered orally to 27 patients suffering from severe chronic generalized psoriasis . The clinical efficacy was evaluated by means of a new index , psoriasis area and severity index ( PASI ) based on severity and area of psoriatic lesions . At doses of 25 mg t.i.d . or 50 mg b.i.d . Ro 10 - -9359 proved to be an extremely potent antipsoriatic drug . A more than 90 % reduction of psoriatic lesions could be seen in 10 patients out of 20 after 4 - 8 weeks of treatment . This good effect lasted about 5 weeks after treatment . Side effects were frequent , but mostly mild and completely reversible after termination of treatment To analyze the effect of possible risk factors , including breastfeeding , on the development of childhood-onset psoriasis , a multicenter case-control study with prospect i ve collection of data was performed . Using a st and ard question naire , personal and specific variables including family history of psoriasis , maternal and environmental tobacco smoke exposure , body mass index ( BMI ) , exclusive and partial breastfeeding for at least 3 and 12 months , cow 's milk intake before 1 year , birth delivery method , and stressful life events were collected during 2009 from 537 patients with psoriasis and 511 controls younger than 18 . Overall , patients more frequently reported exposure to environmental tobacco smoke at home and stressful life events in the year preceding the diagnosis than controls . The odds ratios ( OR ) for smoking and stressful life events were 2.90 ( 95 % confidence interval [CI]=2.27 - 3.78 ) and 2.94 ( 95 % CI=2.28 - 3.79 ) , respectively . In addition , children with psoriasis were more likely to have a higher BMI ( > 26 ) than controls ( OR=2.52 ; 95 % CI=1.42 - 4.49 ) . High BMI , environmental tobacco smoke exposure at home , and stressful life events may influence the development of pediatric psoriasis BACKGROUND Psoriasis is generally thought to be worsened by stress . This presumption has been supported primarily by retrospective studies using question naires . No controlled prospect i ve study on this issue has been performed . METHODS Nine women with moderate plaque psoriasis were enrolled in the study . They all believed that their psoriasis was worsened by stress . They filled in a daily diary with estimations of actual stress levels and grade s of psoriasis . The study of each patient started when her skin disease was in a stable phase and was concluded when her psoriasis was worsened by at least 25 % from the starting level . Psoriasis area severity index scores were recorded at the start , as soon as possible after exacerbation and 2 weeks later .  Stress-related blood sample s  were taken at the same visits . The study was analysed as a nine-case study . RESULTS No clear pattern was found between stress levels and worsening of psoriasis in our nine patients . One patient had elevated stress levels 13 days before exacerbation of psoriasis , but for at least seven patients , there were no identifiable time relationships between stress and psoriasis appearance . For two patients , there were clear elevations of stress levels after psoriasis outbreak . CONCLUSION This limited study does not support the assumption that stress is a worsening factor in psoriasis Summary Background Patients with psoriasis may experience significant psychological and social disabilities . Stress or distress are proposed aggravators of the disease process in psoriasis . Preliminary studies to date have suggested that adjunctive psychological therapies may be effective in the clinical management of psoriasis 
    Output:
    
Our systematic review demonstrates a probable temporal association between different measures of psychological stress and onset , recurrence , and severity of psoriasis .