Relationship between eating disorder duration and treatment outcome: Systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis examine the contribution of duration to treatment outcome for eating disorders. METHOD: Studies (n = 31) were identified that examined associations (r) between duration and 45 different outcomes. We were unable to extract r for seven studies (9 outcomes) and extracted r for 36 outcomes across 24 studies (2,349 participants). Indicators of treatment outcome were heterogeneous and thus a series of different meta-analyses, aimed at increasing homogeneity, were conducted. RESULTS: First, we examined the average effect size for one primary eating disorder related outcome from each of the 24 studies. There was no association between duration and treatment outcome (r = .05, 95% CI: -.03:.13), with high heterogeneity. Second, we conducted three sub-group analyses to explore possible sources of heterogeneity (diagnosis: anorexia nervosa versus bulimia nervosa; nature of the outcome: binary versus continuous; or type of outcome: binary indicator of recovery, eating disorder psychopathology, weight gain). There was no significant moderation or associations between duration and outcome (ranging from .02-.08), with low to medium heterogeneity. Third, two stand-alone analyses examined outcomes related to weight gain (n = 8) and eating disorder psychopathology (n = 5), with nonsignificant rs of .23/-.06, respectively. High levels of heterogeneity were present. DISCUSSION: Duration did not influence treatment outcome across any of our meta-analyses. Increasing homogeneity and power will allow more stable estimates of the impact of duration on outcome to be calculated; to this end, future treatment studies should include outcome related to weight gain (anorexia nervosa) and improvements in eating disorder psychopathology.

ANTECEDENTES: Esta revisión sistemática y metaanálisis examinan la contribución de la duración al resultado del tratamiento para los trastornos de la conducta alimentaria. MÉTODOS: Se identificaron estudios (n = 31) que examinaron las asociaciones (r) entre la duración y 45 diferentes resultados. No fue posible extraer r para siete estudios (nueve resultados) y se extrajo r para 36 resultados en 24 estudios (2349 participantes). Los indicadores del resultado del tratamiento fueron heterogéneos y, por lo tanto, se realizaron una serie de diferentes metaanálisis, destinados a aumentar la homogeneidad. RESULTADOS: Primero, examinamos el tamaño del efecto promedio para un resultado primario relacionado con el trastorno de la conducta alimentaria de cada uno de los 24 estudios. No hubo asociación entre la duración y el resultado del tratamiento (r = .05, IC del 95%: −.03: .13), con alta heterogeneidad. En segundo lugar, realizamos tres análisis de subgrupos para explorar posibles fuentes de heterogeneidad (diagnóstico: anorexia nerviosa versus bulimia nerviosa; naturaleza del resultado: binario versus continuo; o tipo de resultado: indicador binario de recuperación, psicopatología del trastorno alimentario, aumento de peso). No hubo moderación significativa o asociaciones entre la duración y el resultado (rango de .02−.08), con heterogeneidad baja a media. En tercer lugar, dos análisis independientes examinaron los resultados relacionados con el aumento de peso (n = 8) y la psicopatología del trastorno de la conducta alimentaria (n = 5), con una rs no significativa de 0,23/−0,06 respectivamente. Se presentaron altos niveles de heterogeneidad. CONCLUSIONES: La duración no influyó en el resultado del tratamiento en ninguno de nuestros metaanálisis. El aumento de la homogeneidad y el poder permitirá calcular estimaciones más estables del impacto de la duración en el resultado; con este fin, los estudios de tratamiento futuros deben incluir resultados relacionados con el aumento de peso (anorexia nerviosa) y mejoras en la psicopatología de los trastornos de la conducta alimentaria.

Cognitive-behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face-to-face meetings are not possible.

OBJECTIVE: The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence-based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework. METHOD: Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive-behavioral therapy for eating disorders (CBT-ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians. RESULTS: A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT-ED methods. DISCUSSION: Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence-based practice. These are shared to assist clinicians over the period of changed practice.

A Pragmatic Randomized Controlled Trial Targeting Perfectionism in Young Adolescents.

Perfectionism has adverse impacts on mental health and academic outcomes. We evaluated a 5-lesson classroom intervention for young adolescents delivered by teachers for impact on perfectionism, well-being, self-compassion, academic motivation and negative affect, at post-intervention and 3-month follow-up. Classes (N = 636 students, M age = 13.68, SD = 0.60) were randomized to intervention (n = 343) or classes as usual (n = 293). Data were analyzed using linear mixed models adjusted for baseline observation and clustering. At post-intervention no differences were found between the groups. At 3-month follow-up, anxiety showed a significant increase in the control group with no increase in the intervention group (d = 0.23; 95% CI: 0.05, 0.40); females in the control group had a significant decrease in well-being from post-intervention to 3 month follow-up compared to the intervention group (d = 0.33; 95% CI: 0.08, 0.58); students with high levels of perfectionistic concerns in the intervention had significantly lower perfectionistic strivings at 3 month follow-up than the control group ((d = 0.34, 95% CI: 0.19, 0.49). This intervention shows promising results when delivered by teachers. Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621000457842 (April 19, 2021). Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09540-3.

Public Acceptability of Gene Therapy and Gene Editing for Human Use: A Systematic Review.

Gene therapy and gene editing technologies are complex and it can be difficult for the public to understand their possible benefits or side effects. However, patient and public support is critical for the successful adoption of any new technology. Given the recent advances in gene therapy and gene editing, their potential clinical benefits, and the significant attention that has been given to the first-known successful attempt at permanent and heritable changes to the human genome, a systematic review was performed to assess beliefs and attitudes toward gene therapy and gene editing for human use, and to highlight the factors that influence acceptability. A systematic search following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was undertaken in April 2018 to identify articles examining opinions and attitudes regarding the acceptability of gene therapy and gene editing. Overall, 1,561 records were retrieved from 4 databases (Ovid Medline, PsycINFO, Scopus, and Web of Science). Duplicates were removed, and titles and abstracts independently screened, leaving 86 full-text articles assessed for eligibility. Following full-text review, 33 were included, with 5 articles added after forward/backward searching. An additional three articles were added following an updated search in March 2019 (total n = 41). Findings from the studies were integrated according to common themes: the impact of demographics; risks versus benefits of success; treatment specifics (e.g., medical vs. other reasons; disease severity and status; somatic vs. germ line; and mode of delivery); moral or ethical issues; and changes with time. In general, perceptions were positive, particularly for medical reasons and fatal diseases, but were also influenced by perceived risk. Somatic therapies had higher levels of acceptability than germ line therapies. While available in various forms, limitations exist in the measurement of perceptions of gene therapy and gene editing. Treatment acceptability is essential for future clinical trials, so it is important for scientists and clinicians to be clear about the risks and benefits of these technologies, and how these are communicated to the public, while encouraging education about genetic therapies to a broad range of individuals.

Does perfectionism or pursuit of excellence contribute to successful learning? A meta-analytic review.

Confusion exists about the construct of perfectionism, considered to consist of perfectionistic strivings (PS) and perfectionistic concerns (PC). Recent theory suggests that pursuit of excellence is related to PS but differentiated by having a more positive impact. To test this hypothesis, we used a meta-analytic analysis to examine the associations between different measures of perfectionism and academic achievement. Correlations between academic measures (performance, academic burnout and stress, test anxiety, procrastination, self-efficacy, engagement, satisfaction, adjustment, hardiness, learning strategies) and subscales of the Frost Multidimensional Perfectionism Scale, Hewitt Multidimensional Perfectionism Scale, Almost Perfect Scale-Revised, and Child and Adolescent Perfectionism Scale were investigated in students (Mage = 19.31, SD = 4.26). A systematic literature search yielded 67 studies (378 effect sizes). Subscales relating to standards (High Standards, Personal Standards, Self-Oriented Perfectionism) were positively related to academic performance and helpful academic outcomes. Only High Standards, which has a focus on striving for excellence, had negative associations with unhelpful academic outcomes. Two of the four subscales that measured PC (Discrepancy, Doubts about Actions) were negatively related to academic performance, and Discrepancy shared a negative association with helpful academic outcomes. All PC subscales were positively associated with unhelpful academic outcomes. As such, PC are maladaptive for successful learning and a distinction between PS and healthy pursuit of excellence is worth further exploration. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A systematic review of interventions to support the careers of women in academic medicine and other disciplines.

OBJECTIVE: To summarise quantitative evaluations of interventions designed to support the careers of women in academia of any discipline. METHOD: A systematic search of English entries in PubMed, CINAHL and Google Scholar was conducted in September 2017. Methodological quality of the studies was independently assessed by two authors using the Joanna Briggs Institute quality appraisal checklists. Meta-analysis was not possible due to heterogeneity in methods and outcomes; results were synthesised and displayed narratively. RESULTS: Eighteen eligible studies were identified, mostly evaluating programmes in academic medicine departments. The most common interventions were mentoring, education, professional development and/or networking programmes. All programmes took a 'bottom-up' approach in that women were responsible for opting into and devoting time to participation. Study quality was low overall, but all studies reported positive outcomes on at least one indicator. Most often this included improvements in self-rated skills and capabilities, or satisfaction with the programme offered. Results regarding tangible outcomes were mixed; while some studies noted improvements in promotion, retention and remuneration, others did not. CONCLUSIONS: This review suggests that targeted programmes have the potential to improve some outcomes for women in academia. However, the studies provide limited high-quality evidence to provide information for academic institutions in terms of the best way to improve outcomes for women in academia. The success of an intervention appears to be undermined when it relies on the additional labour of those it is intending to support (ie, 'bottom-up' approaches). As such, academic institutions should consider and evaluate the efficacy of 'top-down' interventions that start with change in practice of higher management.