The efficacy and effectiveness of psychological treatments for eating disorders

This thesis considers the effectiveness of psychological treatments for adults with eating disorders, and, as it is can occur in individuals who are morbidly obese, the effectiveness of psychological interventions for eating disorder pathology. In Part I, Chapter 2 we assess whether specialized treatments for patients with anorexia are superior to non-specialized, control treatments by conducting a meta-analysis. We hypothesized that differences in clinical treatment effect would be found in favor of specialized psychological treatments. The meta-analyses indicated that no differences between psychological treatments and control conditions could be established. Our findings suggest that studies including patients over 18 years were more effective on weight gain than studies including younger patients. In high-quality studies and in studies in which therapist training was reported, larger effects were found on both weight gain and on quality of life. At the same time, in sensitivity analyses including high-quality studies only, no differences between psychological and control conditions were found. Part II examines the (cost-)effectiveness of Cognitive behavior therapy-Enhanced (CBT-E), an evidence-based psychological treatment. Chapter 3 presents a consecutive cohort study in which differential (cost-)effectiveness of treatment-as-usual and CBT-E for eating disorder patients with a body mass index over 17.5 kg/m2 was examined. Chapter 4 presents findings on examining differential (cost-)effectiveness of CBT-E compared to treatment-as-usual for patients with anorexia. We hypothesized that effectiveness and cost-effectiveness would be superior in the CBT-E cohort, both for normal weight and underweight patients. For normal weight patients, no comparative differences on clinical outcome were found. In both cohorts, eating disorder pathology decreased. With regard to cost-effectiveness, findings indicated a 71% likelihood of CBT-E dominating TAU and leading to more remissions at lower treatment costs. For underweight patients, findings suggested that weight regain was better in the CBT-E cohort. No other differences in clinical outcome were found. When employing ‘achieving healthy weight’ as effect measure, findings indicate a likelihood of CBT-E leading to better effects than TAU, at higher costs. When employing ‘eating disorder remission’ as effect measure, differences between both cohorts were minimal. Part III, Chapter 5 examines clinical outcome of a multimodal group-based therapy offered to bariatric patients prior to surgery. Findings indicate that patients opting for surgery appeared to benefit less from the treatment offered; they did lose less weight and their poor body image improved less, compared to group participants who did not opt for surgery. At baseline, no differences were found between referred patients who did and those who did not want to undergo bariatric surgery, neither with regard to the degree of obesity, nor with regard to reported negative body image or reported psychological and / or somatic distress. Chapter 6 presents a cross-sectional study examining the association between post-operative behavioral and psychological factors and suboptimal weight loss in a sample of 140 participants who have had bariatric surgery. We hypothesized that reported post-operative eating disorder pathology was associated with suboptimal weight loss. In the examined sample, 19% of patients reported suboptimal weight loss. They reported more symptoms of eating disorder psychopathology, more loss of control over eating and more avoidant behavior due to a poor body image, compared to patients who experienced successful weight loss. Furthermore, they reported higher scores on both an impulsivity and a depression self-report. Having a body mass index  over 50 kg/m2 at time of surgery, and a longer follow-up period after surgery were also associated with poorer weight loss. Losing more weight in the early period after surgery, was associated with better weight outcome later on

Towards a Digital Ecosystem of Trust: Ethical, Legal and Societal Implications

The European vision of a digital ecosystem of trust rests on innovation, powerful technological solutions, a comprehensive regulatory framework and respect for the core values and principles of ethics. Innovation in the digital domain strongly relies on data, as has become obvious during the current pandemic. Successful data science, especially where health data are concerned, necessitates establishing a framework where data subjects can feel safe to share their data. In this paper, methods for facilitating data sharing, privacy-preserving technologies, decentralization, data altruism, as well as the interplay between the Data Governance Act and the GDPR, are presented and discussed by reference to use cases from the largest pan-European social science data research project, SoBigData++. In doing so, we argue that innovation can be turned into responsible innovation and Europe can make its ethics work in digital practice

Taking Care of Innovation: The HRM innovation process in healthcare organizations

__Abstract__ Employees are of crucial importance for the performance of healthcare organizations. (e.g. Townsend & Wilkinson, 2010). Therefore, enhancing our understanding of processes related to the management of these human resources in this sector is very relevant. Human Resource Management (HRM) can be defined as “involving all management decisions related to policies and practices that together shape the employment relationship and are aimed at achieving individual, organizational and / or societal goals” (Boselie, 2010, p. 5). Although the field of Human Resource Management (HRM) has become a widely studied research field throughout the years, there are some research areas that are in need for more investigation. In this dissertation, one of these areas will be examined in-depth. The focus of this dissertation is the innovation process of HRM related practices