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1.
  • Haycock, Philip C., et al. (författare)
  • Association Between Telomere Length and Risk of Cancer and Non-Neoplastic Diseases A Mendelian Randomization Study
  • 2017
  • Ingår i: JAMA Oncology. - American Medical Association. - 2374-2437 .- 2374-2445. ; 3:5, s. 636-651
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>IMPORTANCE: The causal direction and magnitude of the association between telomere length and incidence of cancer and non-neoplastic diseases is uncertain owing to the susceptibility of observational studies to confounding and reverse causation. OBJECTIVE: To conduct a Mendelian randomization study, using germline genetic variants as instrumental variables, to appraise the causal relevance of telomere length for risk of cancer and non-neoplastic diseases. DATA SOURCES: Genomewide association studies (GWAS) published up to January 15, 2015. STUDY SELECTION: GWAS of noncommunicable diseases that assayed germline genetic variation and did not select cohort or control participants on the basis of preexisting diseases. Of 163 GWAS of noncommunicable diseases identified, summary data from 103 were available. DATA EXTRACTION AND SYNTHESIS: Summary association statistics for single nucleotide polymorphisms (SNPs) that are strongly associated with telomere length in the general population. MAIN OUTCOMES AND MEASURES: Odds ratios (ORs) and 95% confidence intervals (CIs) for disease per standard deviation (SD) higher telomere length due to germline genetic variation. RESULTS: Summary data were available for 35 cancers and 48 non-neoplastic diseases, corresponding to 420 081 cases (median cases, 2526 per disease) and 1 093 105 controls (median, 6789 per disease). Increased telomere length due to germline genetic variation was generally associated with increased risk for site-specific cancers. The strongest associations (ORs [ 95% CIs] per 1-SD change in genetically increased telomere length) were observed for glioma, 5.27 (3.15-8.81); serous low-malignant-potential ovarian cancer, 4.35 (2.39-7.94); lung adenocarcinoma, 3.19 (2.40-4.22); neuroblastoma, 2.98 (1.92-4.62); bladder cancer, 2.19 (1.32-3.66); melanoma, 1.87 (1.55-2.26); testicular cancer, 1.76 (1.02-3.04); kidney cancer, 1.55 (1.08-2.23); and endometrial cancer, 1.31 (1.07-1.61). Associations were stronger for rarer cancers and at tissue sites with lower rates of stem cell division. There was generally little evidence of association between genetically increased telomere length and risk of psychiatric, autoimmune, inflammatory, diabetic, and other non-neoplastic diseases, except for coronary heart disease (OR, 0.78 [ 95% CI, 0.67-0.90]), abdominal aortic aneurysm (OR, 0.63 [ 95% CI, 0.49-0.81]), celiac disease (OR, 0.42 [ 95% CI, 0.28-0.61]) and interstitial lung disease (OR, 0.09 [ 95% CI, 0.05-0.15]). CONCLUSIONS AND RELEVANCE: It is likely that longer telomeres increase risk for several cancers but reduce risk for some non-neoplastic diseases, including cardiovascular diseases.</p>
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2.
  • Thornton, Laura M, et al. (författare)
  • The Anorexia Nervosa Genetics Initiative (ANGI): Overview and methods.
  • 2018
  • Ingår i: Contemporary clinical trials. - 1559-2030. ; 74, s. 61-69
  • Tidskriftsartikel (refereegranskat)abstract
    • Genetic factors contribute to anorexia nervosa (AN); and the first genome-wide significant locus has been identified. We describe methods and procedures for the Anorexia Nervosa Genetics Initiative (ANGI), an international collaboration designed to rapidly recruit 13,000 individuals with AN and ancestrally matched controls. We present sample characteristics and the utility of an online eating disorder diagnostic questionnaire suitable for large-scale genetic and population research.ANGI recruited from the United States (US), Australia/New Zealand (ANZ), Sweden (SE), and Denmark (DK). Recruitment was via national registers (SE, DK); treatment centers (US, ANZ, SE, DK); and social and traditional media (US, ANZ, SE). All cases had a lifetime AN diagnosis based on DSM-IV or ICD-10 criteria (excluding amenorrhea). Recruited controls had no lifetime history of disordered eating behaviors. To assess the positive and negative predictive validity of the online eating disorder questionnaire (ED100K-v1), 109 women also completed the Structured Clinical Interview for DSM-IV (SCID), Module H.Blood samples and clinical information were collected from 13,363 individuals with lifetime AN and from controls. Online diagnostic phenotyping was effective and efficient; the validity of the questionnaire was acceptable.Our multi-pronged recruitment approach was highly effective for rapid recruitment and can be used as a model for efforts by other groups. High online presence of individuals with AN rendered the Internet/social media a remarkably effective recruitment tool in some countries. ANGI has substantially augmented Psychiatric Genomics Consortium AN sample collection. ANGI is a registered clinical trial: clinicaltrials.govNCT01916538; https://clinicaltrials.gov/ct2/show/NCT01916538?cond=Anorexia+Nervosa&draw=1&rank=3.
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3.
  • Johnson, Shevaugn, et al. (författare)
  • Internet-delivered cognitive behavioural therapy for perfectionism : Targeting dysmorphic concern
  • 2019
  • Ingår i: Body image. - 1740-1445 .- 1873-6807. ; 30, s. 44-55
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to <em>BDD-body</em>, <em>BDD-positive</em>, and <em>BDD-negative</em> words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.</p>
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4.
  • Johnson, Shevaugn, et al. (författare)
  • Internet-delivered cognitive behavioural therapy for perfectionism : Targeting dysmorphic concern
  • 2019
  • Ingår i: Body image. - Elsevier. - 1740-1445 .- 1873-6807. ; 30, s. 44-55
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to BDD-body, BDD-positive, and BDD-negative words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.</p>
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5.
  • Rozental, Alexander, et al. (författare)
  • Guided web-based cognitive behavior therapy for perfectionism : Results from two different randomized controlled trials
  • 2018
  • Ingår i: Journal of Medical Internet Research. - 1438-8871 .- 1438-8871. ; 20:4
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data.</p><p>Objective: The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom.</p><p>Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial.</p><p>Results: Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85).</p><p>Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.</p>
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6.
  • Rozental, Alexander, et al. (författare)
  • Guided Web-Based Cognitive Behavior Therapy for Perfectionism: Results From Two Different Randomized Controlled Trials
  • 2018
  • Ingår i: Journal of Medical Internet Research. - JMIR PUBLICATIONS, INC. - 1438-8871 .- 1438-8871. ; 20:4
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data. Objective: The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom. Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial. Results: Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85). Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.</p>
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7.
  • Shafran, Roz, et al. (författare)
  • Is the devil in the detail? : A randomised controlled trial of guided internet-based CBT for perfectionism
  • 2017
  • Ingår i: Behaviour Research and Therapy. - 0005-7967 .- 1873-622X. ; 95, s. 99-106
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see this issue). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes <em>d</em> = 0.98 (95% CI: 0.60–1.36) and <em>d</em> = 1.04 (95% CI: 0.66–1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention.</p>
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8.
  • Shafran, Roz, et al. (författare)
  • Is the devil in the detail? A randomised controlled trial of guided internet-based CBT for perfectionism
  • 2017
  • Ingår i: Behaviour Research and Therapy. - PERGAMON-ELSEVIER SCIENCE LTD. - 0005-7967 .- 1873-622X. ; 95, s. 99-106
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>An Internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see this issue). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years; 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d = 0.98 (95% CI: 0.60-1.36) and d = 1.04 (95% CI: 0.66-1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention. (C) 2017 Elsevier Ltd. All rights reserved.</p>
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9.
  • Wade, Tracey D., et al. (författare)
  • Internet-based cognitive behaviour therapy for perfectionism : More is better but no need to be prescriptive
  • 2019
  • Ingår i: Clinical Psychologist. - Wiley-Blackwell Publishing Inc.. - 1328-4207 .- 1742-9552. ; 23:3, s. 196-205
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background</p><p>The current study explored whether higher‐ (up to 8 modules) versus lower‐dose (3 or less modules) unguided internet Cognitive Behaviour Therapy for perfectionism (ICBT‐P) was more effective, and the best method to promote higher dosage.</p><p>Methods</p><p>Two sequential randomised ICBT‐P studies were conducted with participants who self‐identified as having difficulties with perfectionism; in the first participants (<em>N</em> = 51) received 3‐module ICBT‐P or wait‐list, and in the second participants (<em>N</em> = 55) received fixed (asked to complete all 8 modules two per week over 4‐weeks) or flexible format (after completing the first psychoeducational module, participants decided how many/in what order they completed the modules). We examined impact on our primary variables, perfectionistic concerns and standards, and secondary outcomes of negative affect, body image flexibility, and self‐efficacy.</p><p>Results</p><p>More modules were completed in the higher‐ (<em>M</em> modules = 4.36, <em>SD</em> = 3.29) versus lower‐dose (<em>M</em> = 1.96, <em>SD</em> = 1.23) ICBT‐P, <em>d</em> = 0.86 (95% confidence interval: 0.39, 1.34). The latter impacted perfectionism but not secondary outcomes; the former impacted all outcomes (except for self‐efficacy), and within‐group effect size improvements were double in the high‐ compared to low‐dose ICBT‐P. There was no difference between the fixed and flexible formats in terms of the number of modules completed or impact.</p><p>Conclusions</p><p>We can offer a patient‐centred approach to ICBT‐P that is effective, while suggesting completion of more modules can result in larger, more pervasive improvements.</p>
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10.
  • Wade, Tracey D., et al. (författare)
  • Internet-based cognitive behaviour therapy for perfectionism : More is better but no need to be prescriptive
  • 2019
  • Ingår i: Clinical Psychologist. - 1328-4207 .- 1742-9552. ; 23:3, s. 196-205
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: The current study explored whether higher- (up to 8 modules) versus lower-dose (3 or less modules) unguided internet Cognitive Behaviour Therapy for perfectionism (ICBT-P) was more effective, and the best method to promote higher dosage.</p><p>Methods: Two sequential randomised ICBT-P studies were conducted with participants who self-identified as having difficulties with perfectionism; in the first participants (N = 51) received 3-module ICBT-P or wait-list, and in the second participants (N = 55) received fixed (asked to complete all 8 modules two per week over 4-weeks) or flexible format (after completing the first psychoeducational module, participants decided how many/in what order they completed the modules). We examined impact on our primary variables, perfectionistic concerns and standards, and secondary outcomes of negative affect, body image flexibility, and self-efficacy.</p><p>Results: More modules were completed in the higher- (M modules = 4.36, SD = 3.29) versus lower-dose (M = 1.96, SD = 1.23) ICBT-P, d = 0.86 (95% confidence interval: 0.39, 1.34). The latter impacted perfectionism but not secondary outcomes; the former impacted all outcomes (except for self-efficacy), and within-group effect size improvements were double in the high- compared to low-dose ICBT-P. There was no difference between the fixed and flexible formats in terms of the number of modules completed or impact.</p><p>Conclusions: We can offer a patient-centred approach to ICBT-P that is effective, while suggesting completion of more modules can result in larger, more pervasive improvements.</p><p>ANZCTR Trial Number: ACTRN12619000147189.</p>
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