Wait-list Intervention Research Articles

Activating waitlists: Identifying barriers and facilitators to pain self-management while waiting.

Waitlists for pain management services are often extensive, risking psychological and physical decline and patient non-engagement in treatment once accessed. Currently, for outpatient pain management, no standardised waiting list interventions exist, resulting in passive waiting. To arrest prospective wait-related decline(s), this study aimed to identify the barriers and facilitators to pain self-management while waiting, forming the foundation for a waitlist intervention development. An inductive qualitative approach was utilised to explore the barriers and drivers of pain self-management while waiting for chronic pain management. Semi-structured interviews, underpinned by the Theoretical Domains Framework and COM-B model, were conducted with people waiting for pain management services (N = 38). Interviews were audio-recorded, transcribed verbatim, and analysed via reflexive thematic analysis. The analysis demonstrated four thematised barriers and one facilitator: (1) Shunted Around the System (barrier); (2) The Information Gap (barrier); (3) Resisting Adaptation (barrier); (4) Losing Hope (barrier); and (5) Help Yourself or Lose Yourself (facilitator). This study demonstrates the severe emotional and motivational impact of waiting, increasing treatment disengagement. The waitlist represents a prime opportunity for prehabilitation to protect wellbeing and optimise self-management engagement. Infrastructural and interpersonal barriers of poor communication and healthcare professional pain invalidation must be addressed to improve emotional wellbeing and motivation to engage with planned treatment. Enhancing self-efficacy, pain acceptance, self-compassion, and internal HLOC are fundamental to increasing pain self-management. These can all be met within a prehabilitation framework. This study is foundational for the development of psychological prehabilitation in outpatient chronic pain management.

Developing Solutions to the Waitlist Problem for Eating Disorder Treatments.

We examine the small amount of research to date that describes and/or evaluates waitlist interventions as a precursor to treatment for an eating disorder (ED) with the intent to provide recommendations for future research that can further test the efficacy and effectiveness of waitlist interventions. A review of published studies showed the standard of proof about the usefulness of waitlist interventions to be slight, with important gaps in our knowledge. One such gap was whether recovered people with lived experience could provide support to adults waiting for treatment. We briefly present new research evaluating this approach (N = 40), where people waiting for treatment were randomized to waitlist as usual or guided self-help with a trainee psychologist or a person with lived experience. Eight published studies across 10 different programs are described; N = 7 addressed waitlists for children and adolescents, and only three were randomized controlled trials. Our new research did not support the involvement of people with lived experience at this stage of the treatment journey. The results suggest some promise of waitlist interventions. Parents waiting for family-based treatment were able to improve weight and nutritional health in their children and experienced improved self-efficacy with respect to managing the ED. Provision of a waitlist intervention to adults may increase the probability of later engagement in treatment. It is still not possible to conclude whether waitlist interventions improve outcomes over treatment compared to those who did not receive such an intervention. We make five recommendations for future research.

Improving parental self-efficacy in parents of children awaiting neurodevelopmental assessment: A parent group waiting list intervention

Background: Increased parental self-efficacy has been found to have positive effects on parental skills and stress levels, as well as behavioural outcomes for children. This is particularly relevant in relation to neurodivergent children and young people, who tend to present with more behavioural challenges related to emotion regulation difficulties. To assist with the issue of long wait times, a pilot parent group intervention was delivered to parents of children awaiting neurodevelopmental assessment who were presenting with emotion regulation difficulties. The aim of this study was to increase parental self-efficacy. Method: Psychoeducational parent group sessions were delivered online over five sessions to nine families. The sessions included psychoeducation around emotion regulation difficulties and strategies for managing these at home. Results: Parental self-efficacy scores significantly increased following intervention. Conclusions: Parental self-efficacy can be increased via group psychoeducation sessions aimed at understanding and improving emotion regulation.

#2121 The Kidney-specific Psychosocial ASSessment and support (Kidney PASSPORT) feasibility trial

Abstract Background and Aims Psychosocial interventions for depressive and anxiety symptoms are effective in CKD, but studies mainly focus on people on dialysis. Little is known about the role of screening and prevention of common mental health difficulties in early CKD. This trial assessed the research feasibility of an intervention to screen for psychological distress in CKD and deliver prevention approaches for sub-threshold symptoms. The intervention was facilitated by an Assistant Wellbeing Practitioner (AWP), a Band 3 healthcare assistant familiar with renal services and upskilled with specific competency-based training. Method We conducted a mixed-methods, one-year, single-centre, prospective, single-blind, wait-list, randomised controlled feasibility trial. We anticipated screening 250 individuals to identify 100 eligible, with a 40% screening positivity rate, a 45% participation rate and 20% attrition rate, to give 36 participants in the feasibility study. Primary outcomes are shown in Table 1. Potential participants were screened using an online self-completion questionnaire. Participants were randomised to 6 months of immediate or wait-list intervention. Data was collected using online self-report surveys, clinical research forms and semi-structured qualitative interviews. The trial was overseen by a steering committee and received the relevant ethics approvals. Funders included Kidney Care UK, the British Renal Society, the Royal Devon and Exeter Research Capacity Awards and the Exeter Kidney Unit development fund. Results We approached n = 233 people. Feasibility outcomes are shown in Table 2. Due to logistical issues an extension was obtained and in total n = 24 participants were recruited, agreed by the steering committee. All clinical research forms were completed. The most common intervention components were self-management and liaison with the clinical team. The median (interquartile range) difference in baseline and post intervention PHQ-9 score was −5 (−7, 0), n = 19, p = 0.003) and GAD-7 score was −7 (−8, −2), n = 19, p = 0.0002). Qualitative findings showed the AWP was seen as filling in the gaps left by other parts of the service. Key themes were accessibility, time availability, empathy, patient empowerment, and ability to empower the individual. Balance—especially family, work and health—was noted to be a challenge for participants. Importantly, the AWP was able to help participants overcome previous negative experiences. The trial provided valuable learning regarding role implementation, including recruitment, training, work patterns, everyday practicalities, and supervision arrangements. Conclusion We propose a novel intervention for screening and addressing early mental health problems in people with CKD. A single-centre feasibility design was appropriate. The screening positivity rate was lower than anticipated, informing samples for future trials. Outcome data collection via self-report surveys was not feasible. The intervention was well received, with the AWP being valued and self-help and clinical liaison being core elements. Significant reductions in depression and anxiety screening scores were observed. Despite the rigorous design, limitations included slow initial recruitment impacting the sample size and AWP role vulnerability. Future work includes adapting the AWP training and role based on trial learning and considering suitability for other long-term conditions. In conclusion, the AWP role shows promise in routine screening for and prevention of common mental health difficulties in CKD.

The potential value of brief waitlist interventions in enhancing treatment retention and outcomes: a randomised controlled trial

ABSTRACT People with eating disorders are often placed on lengthy waitlists for treatment. This is problematic, as increased time spent on waitlists has been shown to predict dropout. We examined whether providing brief interventions to people on a waitlist improved retention or outcomes in treatment. Participants (N = 85) were referred to a university training clinic for 10-session cognitive behavioural therapy for non-underweight patients with eating disorders (CBT-T). While waitlisted for CBT-T, participants were randomised to one of two waitlist interventions or a control condition. In one waitlist intervention (CRT-Brief), participants received a cognitive remediation therapy session at the start of the waitlist period. In the other waitlist intervention (brief contact), participants were sent a short supportive email and psychoeducation halfway through the waitlist period. The control condition was waitlist as usual. There was no evidence to suggest that the waitlist interventions improved symptoms during the waitlist period or CBT-T. However, participants who received a waitlist intervention were three times more likely to complete treatment. The present study suggests that providing even brief contact while people are waitlisted for eating disorder treatment significantly improves retention. However, replication in a more adequately powered study is required.

Prehabilitation: The underutilised weapon for chronic pain management.

Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.

Waitlist management in child and adolescent mental health care: A scoping review

Background: Although many mental health disorders first emerge during early childhood or adolescence, there is a significant gap between demand and availability of mental health resources, leading to long waitlists for services. Objective: The objective of this scoping review was to identify and characterize the research literature related to the range of waitlist management strategies that have been implemented in outpatient child and adolescent mental health care. Methods: Electronic databases reviewed included: Medline (Ovid), Embase (Ovid), PubMed, PsychINFO, SCOPUS, CINAHL, and ISI Web of Science. Grey literature databases included: OpenGrey, Conference Papers Index, and Proquest Digital Dissertations. Articles were screened by two reviewers in two steps: first by title and abstract, then full text level.Data were extracted using an a-priori developed data extraction framework, which was piloted and modified iteratively. Results: A total of 119 papers related to waitlist interventions in child and adolescent mental health were reviewed. Of these 119 papers, 11% were reviews, summary, or theoretical papers; 8% used a randomized control trial design and 2.5% were trial protocols. Most studies used less rigorous designs, such as uncontrolled before-and- after designs. The large majority focused on just one waitlist strategy each. The most commonly used approaches included: prioritization/triage and initial assessment; brief consultation and advice or brief therapy approaches; group-based models; interim services; increasing capacity; and strategies to decrease non-attendance. Most studies were conducted in the United Kingdom or Canada. Discussion: While mental health systems are complex, most studies examining waitlist initiatives explored the implementation of single initiatives. It is unlikely that a single waitlist strategy can be effective in managing wait times for children’s mental health. Rather, consistent and systemic approaches to address wait times that consider the impact of the reduction approach on the patient, the program, and the community are needed.

ROUTE-T1D: A behavioral intervention to promote optimal continuous glucose monitor use among racially minoritized youth with type 1 diabetes: Design and development

BackgroundType 1 diabetes management is often challenging during adolescence, and many youth with type 1 diabetes struggle with sustained and optimal continuous glucose monitor (CGM) use. Due to racial oppression and racially discriminatory policies leading to inequitable access to quality healthcare and life necessities, racially minoritized youth are significantly less likely to use CGM. MethodsROUTE-T1D: Research on Optimizing the Use of Technology with Education is a pilot behavioral intervention designed to promote optimal CGM use among racially minoritized youth with type 1 diabetes. Intervention strategies include problem solving CGM challenges and promoting positive caregiver-youth communication related to CGM data. ResultsThis randomized waitlist intervention provides participants with access to three telemedicine sessions with a Certified Diabetes Care and Education Specialist. Caregiver participants are also connected with a peer-parent coach. ConclusionHypothesized findings and anticipated challenges are discussed. Future directions regarding sustaining and optimizing the use of diabetes technology among racially minoritized pediatric populations are reviewed.

Changes of resilience in psychiatric nurses by psychoeducation to improve professionalism: A waiting list controlled trial in Japan

Aim: The present study aimed to examine changes in resilience after a psychoeducational intervention to improve professionalism in psychiatric nurses.Methods: A psychoeducation program for psychiatric nurses was developed, and 36 participants were randomly allocated to active intervention and waiting list intervention groups. The S-H Resilience Test was used to assess resilience twice (before and after the intervention/control period), and statistical comparisons were conducted according to time point.Results: Distributions of the resilience scale scores (total and three subscales) in the intervention and control phases were compared before and after psychoeducation or observation. For the intervention phase, total and social support subscale scores significantly increased post-intervention (p<0.05). Resilience types were compared between the two time points in the intervention and control phases, and there were significant changes in the intervention phase (positive type resilience increased).Conclusion: This psychoeducation approach to improve professionalism in psychiatric nurses may be effective in enhancing resilience, particularly by facilitating social support and positive attitudes in participants.

Examining the feasibility of a parental self-help intervention for families awaiting pediatric eating disorder services.

Waitlists for eating disorder (ED) services grew immensely during the COVID-19 pandemic. To address this, we studied the feasibility of a novel parental self-help waitlist intervention. Parents of a child/adolescent (7-17 years) awaiting pediatric ED services were provided with our intervention, adapted from the family-based treatment model, and consisting of videos and reading material with no therapist involvement. Parent-reported child/adolescent weight was collected weekly 6 weeks pre-intervention, 2 weeks during the intervention, and 6-week post-intervention. Recruitment and retention rates were calculated. Regression-based interrupted time series analyses were completed to measure changes in the rate of weight gain. Ninety-seven parents were approached, and 30 agreed to participate (31% recruitment rate). All but one completed end-of-study measures (97% retention rate). The average rate of weight gain was 0.24 lbs/week pre-intervention, which increased significantly to 0.78 lbs/week post-intervention (p < .034). Our findings provide preliminary evidence that this intervention is feasible. Future research is needed to confirm the efficacy of this intervention on a larger scale. The COVID-19 pandemic has resulted in several challenges in providing care for children and adolescents with eating disorders, including long waiting lists and delays in treatment. This study suggests that providing parents on a waitlist with educational videos and reading material is acceptable to parents, and may even help in improving the child's symptoms of an eating disorder.

A Waitlist Intervention for Transgender Young People and Psychosocial Outcomes.

Recent referrals of transgender young people to specialist gender services worldwide have risen exponentially, resulting in wait times of 1-2 years. To manage this demand, we introduced an innovative First Assessment Single-Session Triage (FASST) clinic that provides information and support to young people and their families and triages them onto a secondary waitlist for subsequent multidisciplinary care. Although FASST has been shown to substantially reduce initial wait times, its clinical impact is unknown. FASST was evaluated by analysis of clinical surveys and qualitative interviews. A total of 142 patients were surveyed before and after FASST, and comparison was made to a historical control group of 120 patients who did not receive FASST. In-depth interviews were also held with FASST attendees (n = 14) to explore experiences of FASST, and inductive content analysis was performed. After FASST, there were improvements in depression (standardized mean difference [SMD] = -0.24; 95% confidence interval [CI]: -0.36 to -0.11; P < .001), anxiety (SMD = -0.14; 95% CI: -0.26 to -0.02; P = .025) and quality of life (SMD = .39; 95% CI: 0.23 to 0.56; P < .001). Compared with historical controls, those attending FASST showed reduced depression (SMD = -0.24; 95% CI: -0.50 to 0.01; P = .065) and anxiety (SMD = -0.31; 95% CI: -0.57 to -0.05; P = .021). FASST attendees qualitatively described an increased sense of agency, which was related to improved outlook, validation, sense of self, and confidence. Given burgeoning waitlists of pediatric gender services worldwide, this study suggests FASST may prove a useful model of care elsewhere.

A Pilot Study of the Acceptability of a Dance Café for People with Severe Dementia

<strong>Context:</strong> Dance has been suggested as a way of helping people with advanced dementia, providing meaningful involvement and activity. <strong>Objectives:</strong> To investigate if individuals with advanced dementia would be able to take part in dancing in a Dance Café within a residential home setting and undertake the assessment of nutrition, quality of life, balance and mobility. <strong>Methods:</strong> A wait-list intervention approach was used, with residents allocated randomly to the intervention or a control group, who received the dance intervention later. A Dance Café was held weekly for 8 weeks, and assessments were made of weight, nutrition, balance, mobility and quality of life. Focus groups were held with staff and family members after the intervention period to assess their opinions. <strong>Findings:</strong> The regular assessments of nutrition, balance and quality of life were obtained for the residents with dementia, and they were able to join in the Dance Café. No conclusions could be made from the limited quantitative results; in the qualitative assessment, however, the staff and families all felt the participants had benefitted from the Dance Café in terms of improved mobility and positive psychosocial effects. <strong>Limitations:</strong> The small size of the intervention group prevented any statistical analysis of the quantitative assessments. <strong>Implications:</strong> It is possible to undertake a Dance Café with people with severe dementia, and assessments of nutrition and mobility can be undertaken. Further research with a larger group would be needed to investigate its effectiveness.

Implementation and Evaluation of Life-planning Lecture to Enhance Perspective-Taking among High School Students: A School-based Nonrandomized Waitlist Intervention Study in Japan.

Introduction: The Australian “empathy session,” which is a parenting program aimed at alleviating postpartum depression by increasing empathy among expecting couples, was adapted to a life-planning education program for Japanese high school students. In this present study, we aimed to assess changes in high school students’ empathy levels. Methods: A nonrandomized, controlled, waitlist intervention was performed in 210 first-year students. They were divided into intervention and waitlist control groups. The life-planning lecture consisted of two parts: (1) reproductive health and (2) empathy and communication skills. The main outcome indicator was the Perspective-Taking subscale of an empathy index. Logistic regression was used to examine the association between the intervention and change in the Perspective-Taking scale score controlling for background factors. Results: As per our findings, a significant difference was noted in the scale scores of Perspective-Taking before and after the program within the intervention group (3.76 ± 0.61 before the lecture and 3.86 ± 0.64 after the lecture; P = 0.01). In the between-group analysis, the likelihood of an increase in the scale score of Perspective-Taking was significantly higher in the intervention group (OR = 2.29, 95 % confidence interval = 1.23-4.26). Conclusions: Japanese high school students’ Perspective-Taking improved through learning reproductive life-planning and communication skills.

Effects of a wearable technology-based physical activity intervention on sleep quality in breast cancer survivors: the ACTIVATE Trial.

Physical activity interventions can improve sleep quality in breast cancer survivors. This paper examines the effects of the ACTIVATE Trial, a wearable-based physical activity intervention (Garmin Vivofit2® coupled with behavioral feedback, goal setting, and health coaching) on sleep outcomes. Post-primary treatment, inactive, postmenopausal breast cancer survivors were recruited and randomized to primary intervention or waitlist. Wrist-worn actigraphy (sleep onset latency, SOL; total sleep time, TST; sleep efficiency, SE; wake after sleep onset, WASO; and number of awakenings, NWAKE) and questionnaire-derived sleep measures (Pittsburgh Sleep Quality Index) were assessed at baseline (T1), 12weeks (end of primary intervention and start of waitlist intervention, T2), and at 24weeks (T3). Eighty-three women (mean age = 62years) were randomized; trial retention was 94% at T2 and 87% at T3. At T2, primary intervention participants had greater improvements in WASO (- 5.7min, 95% CI - 11.7 to - 0.2) and NWAKE compared with the waitlist arm (- 2.0, 95% CI - 3.6 to - 0.4). At T3, within-group improvements were observed for SE (both groups), WASO (both groups), NWAKE (primary intervention group only), total PSQI score (primary intervention group), and sleep efficacy (primary intervention group). The intervention reduced actigraphy-measured sleep disturbances. Within-group analyses suggest that improvements in sleep quality are sustained over a longer duration, and there may be similar benefits from an abridged intervention (wearable device only). Actigraphy-measured effects appeared stronger in participants who were poor sleepers at study entry. Wearable technology can increase physical activity and improve sleep for breast cancer survivors.

SOCIAL MEDIA AND SOCIAL WELL-BEING IN LATER LIFE

Social well-being is important to health, but maintaining social relations often becomes difficult in later life due to retirement, chronic disease, and the death of spouses and friends. Social media platforms, such as Facebook and Twitter, present accessible and low cost communication technologies that are associated with enhanced feelings of social connection and reduced loneliness in younger age groups. This paper examines whether similar benefits might arise for adults at older ages. Using a four-week social media training workshop as a randomized, controlled wait-list intervention, this study examines whether social benefits are realized among a group of novice social media users, aged 65+. Measures of social well-being, including social capital, loneliness, social connectedness, and social provisions, were assessed at pre- and multiple post-test intervals for differences related to social media learning. Findings revealed only small differences between groups in one dimension of social connectedness, that of social integration. As these findings seemingly contradict studies conducted with younger persons, the contexts of social media use in older adulthood are discussed. These include the relevance of lower social media adoption rates, as well as influences that intersect with an older person’s life stage, such as gaps in network coverage on technological platforms, perceptions of the value of weak connections, and a reduced digital skills base. These additional factors are relevant to understanding disparity in the benefits that can be obtained through the use of social media and highlight the differing needs that social media fulfill at varying life stages.

Placebo, usual care and wait-list interventions for all mental health disorders

Placebo, usual care and wait-list interventions for all mental health disorders

Cognitive behavioral group therapy for patients with physical diseases and comorbid depressive or adjustment disorders on a waiting list for individual therapy: results from a randomized controlled trial

BackgroundDepressive and adjustment disorders are highly prevalent in patients with physical diseases and are associated with poorer quality of life, increased morbidity and mortality, as well as higher healthcare costs. Access to mental health care holds strong importance for these patients, although waiting times for outpatient individual psychotherapy in Germany are often long. Attending an intervention while waiting for individual therapy could improve this problem. For this purpose, we developed an eight-session cognitive behavioral group therapy (STEpS) and tested its efficacy in a randomized controlled trial.MethodsSeventy-six patients with chronic physical diseases and comorbid depressive or adjustment disorders were randomized to either STEpS or a waiting list control group. The primary outcome was self-reported depression measured by the Hospital Anxiety and Depression Scale (HADS-D), while the secondary outcomes included global psychological distress and health-related quality of life. Data was assessed at baseline, post-treatment and 2-month follow-up and was analyzed based on intention-to-treat.ResultsCompared to the control group, the STEpS group showed significantly less depression (d = 0.37; p = .009) and significantly higher quality of life (mental: d = 0.47; p = .030; physical: d = 0.70; p = .001) at post-treatment. The groups did not differ in global psychological distress. At 2-month follow-up, the STEpS group indicated significantly higher subjective physical health (d = 0.43; p = .046), but did not differ from the control group in the remaining outcomes.ConclusionsSTEpS proved effective in improving depression and health-related quality of life in the short term but did not reveal effects on mental outcomes at 2-month follow-up. Nonetheless, the implementation of STEpS as a waiting list intervention prior to individual therapy could help patients to handle long waiting periods in outpatient care.Trial registrationGerman Clinical Trials Register DRKS00005140 (27 August 2013).

"Great powers and great responsibilities": A brief comment on "A brief mobile app reduces nonsuicidal and suicidal self-injury: Evidence from three randomized controlled trials" (Franklin et al., 2016).

Online and mobile mental health applications (apps) herald exciting new opportunities for the treatment and prevention of self-injurious thoughts and behaviors (SITBs). With such rapid technological advances, it is paramount that health care innovation not be achieved to the detriment of intervention quality. Franklin et al.'s (2016) therapeutic evaluative conditioning (TEC) app is a novel and timely addition to the mobile health landscape; uncommonly for such apps, it is evidence based. There are, however, several crucial challenges to be surmounted for TEC to be successful; arguably, interventions ought to build lasting skills that can be subsequently and consciously recruited to manage distress beyond the intervention period. Furthermore, SITBs are a coping mechanism (albeit maladaptive); thus, extinguishing SITBs via TEC must be bolstered by the development of alternative coping strategies, particularly if the psychological distress that underlies SITBs is not addressed therapeutically. Stigma exacerbates the psychological distress of those engaging in SITBs; therefore, we question whether the types of stimuli employed in TEC may further add to this stigma, potentially affecting future help seeking. One solution may be to explore a positive-only TEC; enhancing positive self-worth may provide a more sustainable and meaningful treatment target, particularly when used as an adjunct to therapy or as a waiting list intervention. Mobile interventions for SITBs bring unique ethical challenges, including individuals' right to be fully informed about potentially distressing stimuli. This commentary aims to highlight the methodological and ethical challenges faced by TEC and encourage further discussion around this topic. (PsycINFO Database Record

Early psychological interventions to treat acute traumatic stress symptoms.

The amelioration of psychological distress following traumatic events is a major concern. Systematic reviews suggest that interventions targeted at all of those exposed to such events are not effective at preventing post traumatic stress disorder (PTSD). Recently other forms of intervention have been developed with the aim of treating acute traumatic stress problems. To perform a systematic review of randomised controlled trials of all psychological treatments and interventions commenced within three months of a traumatic event aimed at treating acute traumatic stress reactions. The review followed the guidelines of the Cochrane Collaboration. Systematic searches were performed of of CCDAN Registers up to August 2008. Editions of key journals were searched by hand over a period of two years; personal communication was undertaken with key experts in the field; online discussion fora were searched. Randomised controlled trials of any psychological intervention or treatment designed to reduce acute traumatic stress symptoms, with the exception of single session interventions. Data were entered and analysed for summary effects using Review Manager 5.0 software. Standardised mean differences were calculated for continuous variable outcome data. Relative risks were calculated for dichotomous outcome data. When statistical heterogeneity was present a random effects model was applied. Fifteen studies (two with long term follow-up studies) were identified examining a range of interventions.In terms of main findings, twelve studies evaluated brief trauma focused cognitive behavioural interventions (TF-CBT). TF-CBT was more effective than a waiting list intervention (6 studies, 471 participants; SMD -0.64, 95% CI -1.06, -0.23) and supportive counselling (4 studies, 198 participants; SMD -0.67, 95% CI -1.12, -0.23). Effects against supportive counselling were still present at 6 month follow-up (4 studies, 170 participants; SMD -0.64, 95% CI -1.02, -0.25). There was no evidence of the effectiveness of a structured writing intervention when compared against minimal intervention (2 studies, 149 participants; SMD -0.15, 95% CI -0.48, 0.17). There was evidence that individual TF-CBT was effective for individuals with acute traumatic stress symptoms compared to both waiting list and supportive counselling interventions. The quality of trials included was variable and sample sizes were often small. There was considerable clinical heterogeneity in the included studies and unexplained statistical heterogeneity observed in some comparisons. This suggests the need for caution in interpreting the results of this review. Additional high quality trials with longer follow up periods are required to further test TF-CBT and other forms of psychological intervention.

Cigarette smoking and bladder cancer: an epidemiological inquiry in West Yorkshire.

Results are given of a case-control study on bladder cancer in West Yorkshire. The aim of the study was to assess what risks exist for cigarette smoking in the United Kingdom and also to investigate if a dose response effect was present. The study shows for the first time in the United Kingdom a positive but weak relationship between cigarette smoking and bladder cancer. Close examination of the data with regard to this effect shows that a complex set of relationships result when the quantity smoked and the period of smoking are taken into account. A dose response effect is weakly demonstrated when a medium quantity of cigarettes are smoked but it is not present at all in those who smoked most cigarettes for the longest periods. No risk appears to exist for those who have smoked only filter cigarettes. The results are contrasted with similar studies and the significance of the observations are discussed.