Other Psychiatry and Psychology Commons^™

Circus In Motion: A Multimodal Exergame Supporting Vestibular Therapy For Children With Autism, Oscar Peña, Franceli L. Cibrian, Monica Tentori

Engineering Faculty Articles and Research

Exergames are serious games that involve physical exertion and are thought of as a form of exercise by using novel input models. Exergames are promising in improving the vestibular differences of children with autism but often lack of adaptation mechanisms that adjust the difficulty level of the exergame. In this paper, we present the design and development of Circus in Motion, a multimodal exergame supporting children with autism with the practice of non-locomotor movements. We describe how the data from a 3D depth camera enables the tracking of non-locomotor movements allowing children to naturally interact with the exergame . A …

Optimism And Risk Of Incident Hypertension: A Target For Primordial Prevention, Laura D. Kubzansky, Julia K. Boehm, Andrew R. Allen, Loryana L. Vie, Tiffany E. Ho, Claudia Trudel-Fitzgerald, Hayami K. Koga, Lawrence M. Scheier, Martin E. P. Seligman

Psychology Faculty Articles and Research

Aims

Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations.

Methods

Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and …

Sense Of Purpose In Life And Five Health Behaviors In Older Adults, Eric S. Kim, Koichiro Shiba, Julia K. Boehm, Laura D. Kubzansky

Psychology Faculty Articles and Research

Accumulating evidence shows that a higher sense of purpose in life is associated with lower risk of chronic conditions and premature mortality. Health behaviors might partially explain these findings, however, the prospective association between sense of purpose and health behaviors is understudied. We tested whether a higher sense of purpose at baseline was associated with lower likelihood of developing unhealthy behaviors over time. Prospective data were from the Health and Retirement Study, a national sample of U.S. older adults. Our sample included 13,770 adults assessed up to five times across eight years. Among people who met recommended guidelines for a …

A Comprehensive Examination Of The Immediate Recovery Of Children Following Tonsillectomy And Adenoidectomy, Bryan K. Lao, Zeev N. Kain, Dina Khoury, Brooke N. Jenkins, Jeremy Prager, Robert S. Stevenson, Brenda Golianu, Jeannie Zuk, Jeffrey I. Gold, Qiu Zhong, Michelle A. Fortier

Psychology Faculty Articles and Research

Objectives

Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first two weeks following surgery.

Study design

Observational, longitudinal study.

Setting

Four major pediatric hospitals in the U.S. consisting of Children's Hospital of Orange County, Children's Hospital of Los Angeles, Lucile Packard Children's Hospital, and Children's Hospital Colorado.

Subjects

and Methods: Participants included 827 patients between 2 and 15 years of age who underwent tonsillectomy with or without adenoidectomy surgery. Baseline and demographic …

Demographic Predictors Of Adult Behaviors In The Pediatric Postoperative Environment, Natasha H. Hikita, Amber Osorno, Carlie Taurosa, Michelle A. Fortier, Zeev N. Kain, Brooke N. Jenkins

Student Scholar Symposium Abstracts and Posters

Over 85% of children experience postoperative pain. If poorly treated, pediatric postoperative pain may lead to various negative health outcomes. Adult behaviors may be associated with child experiences in the postoperative environment. For example, adult behaviors such as distraction, humor, and coping advice divert a child’s attention away from their pain and thus, may significantly reduce child postoperative distress. In contrast, adult behaviors such as empathy, reassurance, and apology direct a child’s attention towards their pain which may increase a child’s overall postoperative distress. Moreover, patient demographic factors, like child ethnicity, may significantly alter the frequency of use of these …

Positive Emotions And Favorable Cardiovascular Health: A 20-Year Longitudinal Study, Julia K. Boehm, Ying Chen, Farah Qureshi, Jackie Soo, Peter Umokoro, Rosalba Hernandez, Donald Lloyd-Jones, Laura D. Kubzansky

Psychology Faculty Articles and Research

No studies have examined whether positive emotions lead to favorable cardiovascular health (CVH) early in the lifespan, before cardiovascular disease is diagnosed. Moreover, the direction of the association has not been thoroughly investigated. Among younger adults, we investigated whether baseline positive emotions were associated with better CVH over 20 years. We also considered whether baseline CVH was associated with subsequent positive emotions during the same period.

Participants included 4196 Black and White men and women from the Coronary Artery Risk Development in Young Adults Study. Positive emotions and cardiovascular-related parameters were each assessed in 1990 (this study's baseline), with repeated …

Supporting Self-Regulation Of Children With Adhd Using Wearables: Tensions And Design Challenges, Franceli L. Cibrian, Kimberley D. Lakes, Arya Tavakoulnia, Kayla Guzman, Sabrina Schuck, Gillian R. Hayes

Engineering Faculty Articles and Research

The design of wearable applications supporting children with Attention Deficit Hyperactivity Disorders (ADHD) requires a deep understanding not only of what is possible from a clinical standpoint but also how the children might understand and orient towards wearable technologies, such as a smartwatch. Through a series of participatory design workshops with children with ADHD and their caregivers, we identified tensions and challenges in designing wearable applications supporting the self-regulation of children with ADHD. In this paper, we describe the specific challenges of smartwatches for this population, the balance between self-regulation and co-regulation, and tensions when receiving notifications on a smartwatch …

Maternal Depressive Symptoms Predict General Liability In Child Psychopathology, Danielle A. Swales, Hannah R. Snyder, Benjamin L. Hankin, Curt A. Sandman, Laura M. Glynn, Elyssia Poggi Davis

Psychology Faculty Articles and Research

Objective: The current study examines how maternal depressive symptoms relate to child psychopathology when structured via the latent bifactor model of psychopathology, a new organizational structure of psychopathological symptoms consisting of a general common psychopathology factor (p-factor) and internalizing- and externalizing-specific risk.

Method: Maternal report of depressive symptoms (Beck Depression Inventory – II) and child psychopathological symptoms (Child Behavior Checklist and Children’s Behavior Questionnaire) were provided by 554 mother-child pairs. Children in the sample were 7.7 years old on average (SD = 1.35, range = 5–11 years), and were 49.8% female, 46% Latinx, and 67% …

Variable Magnitude And Frequency Financial Reinforcement Is Effective At Increasing Adults’ Free-Living Physical Activity, Vincent Berardi, Melbourne Hovell, Jane C. Hurley, Christine B. Phillips, John Belletierre, Michael Todd, Marc A. Adams

Psychology Faculty Articles and Research

Financial rewards can increase health behaviors, but little research has quantified the effects of different reinforcement schedules on this process. This analysis compares the average moderate-to-vigorous physical activity (MVPA) associated with six distinct positive reinforcement schedules implemented within a physical activity promotion clinical trial. In this trial, participants (N = 512) wore an accelerometer for 1 year and were prescribed one of two types of MVPA goals: a static 30-min goal or an adaptive goal based on the MVPA produced over the previous 9 days. As participants met goals, they transitioned through a sequence of reinforcement stages, beginning with …

Unpredictable Maternal Behavior Is Associated With A Blunted Infant Cortisol Response, Amanda N. Noroña-Zhou, Alyssa Morgan, Laura M. Glynn, Curt A. Sandman, Tallie Z. Baram, Hal S. Stern, Elyssia Poggi Davis

Psychology Faculty Articles and Research

Background

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is associated with poor physical and mental health. Early-life adversity may dysregulate cortisol response to subsequent stress. This study examines the association between patterns of maternal behavior and infant stress response to a challenge. Specifically, we test whether infant exposure to unpredictable maternal sensory signals is related to the cortisol response to a painful stressor.

Method

Participants were 102 mothers and their children enrolled in a longitudinal study. Patterns of maternal sensory signals were evaluated at 6 and 12 months during a 10-min mother–infant play episode. Entropy rate was calculated as a quantitative …

The Project Talent Twin And Sibling Study: Zygosity And New Data Collection, Carol A. Prescott, Ellen E. Walters, Thalida Em Arpawong, Catalina Zavala, Tara L. Gruenewald, Margaret Gatz

Psychology Faculty Articles and Research

The Project Talent Twin and Sibling (PTTS) study includes 4481 multiples and their 522 nontwin siblings from 2233 families. The sample was drawn from Project Talent, a U.S. national longitudinal study of 377,000 individuals born 1942–1946, first assessed in 1960 and representative of U.S. students in secondary school (Grades 9–12). In addition to the twins and triplets, the 1960 dataset includes 84,000 siblings from 40,000 other families. This design is both genetically informative and unique in facilitating separation of the ‘common’ environment into three sources of variation: shared by all siblings within a family, specific to twin-pairs, and associated with …

Immune-Endocrine Links To Gregariousness In Wild House Mice, Patricia C. Lopes, Esther H. D. Carlitz, Morgan Kindel, Barbara König

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Social interactions are critically important for survival and impact overall-health, but also impose costs on animals, such as exposure to contagious agents. The immune system can play a critical role in modulating social behavior when animals are sick, as has been demonstrated within the context of “sickness behaviors.” Can immune molecules affect or be affected by social interactions even when animals are not sick, therefore serving a role in mediating pathogen exposure? We tested whether markers of immune function in both the blood and the brain are associated with gregariousness, quantified as number of animals interacted with per day. To …

Human Milk Omega-3 Fatty Acid Composition Is Associated With Infant Temperament, Jennifer Hahn-Holbrook, Adi Fish, Laura M. Glynn

Psychology Faculty Articles and Research

There is growing evidence that omega-3 (n-3) polyunsaturated fatty-acids (PUFAs) are important for the brain development in childhood and are necessary for an optimal health in adults. However, there have been no studies examining how the n-3 PUFA composition of human milk influences infant behavior or temperament. To fill this knowledge gap, 52 breastfeeding mothers provided milk samples at 3 months postpartum and completed the Infant Behavior Questionnaire (IBQ-R), a widely used parent-report measure of infant temperament. Milk was assessed for n-3 PUFAs and omega-6 (n-6) PUFAs using gas-liquid chromatography. The total fat and the ratio of n6/n-3 fatty acids …

The Healing Power Of The Arts - Drama Therapy And The Use Of Theatre In The Treatment Of Trauma, Brooklyn Snyder

Student Scholar Symposium Abstracts and Posters

Theatre is an incredibly valuable therapeutic tool. In this thesis, I explore the ways in which trauma can reshape individuals lives, both cognitively and physically, impeding their sense of self, ability to trust, engagement, and many other seemingly ordinary aspects of day to day life that those of us unaffected by trauma take for granted. Additionally, I cover how employing theatrical tools, like improvisation and role play, can act as a beneficial treatment option for those who have suffered a traumatic past. Drama therapy allows individuals to reconnect with their bodies and their minds, gain new perspectives on their experiences, …

The Complex Relationship Between Celebrity-Driven Magazines And Depictions Of Fertility At Advanced Reproductive Ages, Brennan Peterson

Marriage and Family Therapy Faculty Articles and Research

"In this issue of the Journal of Women’s Health, Willson and colleagues explore how age and fertility are portrayed in celebrity-driven magazines.¹ Specifically, they examine if popular media depictions of celebrity pregnancies present accurate information related to age and fertility, the use of assisted reproductive technology (ARTs), and pregnancy-related risks associated with advanced maternal age (AMA >35 years). Their study provides an important viewpoint related to the impact of media on reproductive perceptions, and its potential intersection with delayed childbearing, fertility awareness, and reproductive decision making."

Identifying Depression In The National Health And Nutrition Examination Survey Data Using A Deep Learning Algorithm, Jihoon Oh, Kyongsik Yun, Uri Maoz, Tae-Suk Kim, Jeong-Ho Chae

Psychology Faculty Articles and Research

Background

As depression is the leading cause of disability worldwide, large-scale surveys have been conducted to establish the occurrence and risk factors of depression. However, accurately estimating epidemiological factors leading up to depression has remained challenging. Deep-learning algorithms can be applied to assess the factors leading up to prevalence and clinical manifestations of depression.

Methods

Customized deep-neural-network and machine-learning classifiers were assessed using survey data from 19,725 participants from the NHANES database (from 1999 through 2014) and 4949 from the South Korea NHANES (K-NHANES) database in 2014.

Results

A deep-learning algorithm showed area under the receiver operating characteristic curve (AUCs) …

Postoperative Pain: Factors And Tools To Improve Pain Management In Children, Mai M. Makhlouf, Eric Robles Garibay, Brooke N. Jenkins, Zeev N. Kain, Michelle Fortier

Psychology Faculty Articles and Research

Outpatient surgery has made it increasingly common for parents to manage pain in the home setting. Studies have shown that parents often under treat pain, leaving children vulnerable to the negative side effects of suboptimal pain management. Multiple factors affect pain management like child’s age and developmental stage, language, cultural values like stoicism, parental beliefs about medication, biological differences among groups, etc. Understanding all the factors involved can help healthcare providers and parents better understand pain and contribute to optimal pain management. Multiple tools and technological interventions have been created to help create a better understanding of pain and a …

An Integration-To-Bound Model Of Decision-Making That Accounts For The Spectral Properties Of Neural Data, Ramón Guevara Erra, Marco Arbotto, Aaron Schurger

Psychology Faculty Articles and Research

Integration-to-bound models are among the most widely used models of perceptual decision-making due to their simplicity and power in accounting for behavioral and neurophysiological data. They involve temporal integration over an input signal (“evidence”) plus Gaussian white noise. However, brain data shows that noise in the brain is long-term correlated, with a spectral density of the form 1/fα (with typically 1 < α < 2), also known as pink noise or ‘1/f’ noise. Surprisingly, the adequacy of the spectral properties of drift-diffusion models to electrophysiological data has received little attention in the literature. Here we propose a model of accumulation of evidence for decision-making that takes into consideration the spectral properties of brain signals. We develop a generalization of the leaky stochastic accumulator model using a Langevin equation whose non-linear noise term allows for varying levels of autocorrelation in the time course of the decision variable. We derive this equation directly from magnetoencephalographic data recorded while subjects performed a spontaneous movement initiation task. We then propose a nonlinear model of accumulation of evidence that accounts for the ‘1/f’ spectral properties of brain signals, and the observed variability in the power spectral properties of brain signals. Furthermore, our model outperforms the standard drift-diffusion model at approximating the empirical waiting time distribution.

Exploring The Impact Of Challenging Behaviors On Treatment Efficacy In Autism Spectrum Disorder, Juliana Hoag

Computational and Data Sciences (MS) Theses

The focus of this study was to explore the impact of challenging behaviors on Applied Behaviors Analysis treatment in Autism Spectrum Disorder. The prevalence of ASD is on the rise, so it is important that we understand how patients are responding to treatment. In this study, we cluster patients (N=854) based on their eight observed challenging behaviors using k-means, a machine learning algorithm, and then perform a multiple linear regression analysis to find significant differences between average exemplars mastered. The goal of this study was to expand the research in the area of ABA treatment for ASD and to help …

The Unfolding Argument: Why Iit And Other Causal Structure Theories Cannot Explain Consciousness, Adrian Doerig, Aaron Schurger, Kathryn Hess, Michael H. Herzog

Psychology Faculty Articles and Research

How can we explain consciousness? This question has become a vibrant topic of neuroscience research in recent decades. A large body of empirical results has been accumulated, and many theories have been proposed. Certain theories suggest that consciousness should be explained in terms of brain functions, such as accessing information in a global workspace, applying higher order to lower order representations, or predictive coding. These functions could be realized by a variety of patterns of brain connectivity. Other theories, such as Information Integration Theory (IIT) and Recurrent Processing Theory (RPT), identify causal structure with consciousness. For example, according to …

Rationale, Design, And Baseline Characteristics Of Walkit Arizona: A Factorial Randomized Trial Testing Adaptive Goals And Financial Reinforcement To Increase Walking Across Higher And Lower Walkable Neighborhoods, Marc A. Adams, Jane Hurley, Christine Phillips, Michael Todd, Siddhartha Angadi, Vincent Berardi, Melbourne F. Hovell, Steven Hooker

Psychology Faculty Articles and Research

Little change over the decades has been seen in adults meeting moderate-to-vigorous physical activity (MVPA) guidelines. Numerous individual-level interventions to increase MVPA have been designed, mostly static interventions without consideration for neighborhood context. Recent technologies make adaptive interventions for MVPA feasible. Unlike static interventions, adaptive intervention components (e.g., goal setting) adjust frequently to an individual's performance. Such technologies also allow for more precise delivery of “smaller, sooner incentives” that may result in greater MVPA than “larger, later incentives”. Combined, these factors could enhance MVPA adoption. Additionally, a central tenet of ecological models is that MVPA is sensitive to neighborhood environment …

Children And Their Parents’ Assessment Of Postoperative Surgical Pain: Agree Or Disagree?, Olivia Kaminsky, Michelle Fortier, Brooke N. Jenkins, Robert S. Stevenson, Jeffrey I. Gold, Jeannie Zuk, Brenda Golianu, Sherrie H. Kaplan, Zeev N. Kain

Psychology Faculty Articles and Research

Objective

The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration.

Methods

This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain …

Characterizing Range Anxiety In Electric Vehicle Users, Maiia Tolia-Shah, Brenda Gutierrez, Sook Mun (Alice) Wong, Uri Maoz

Student Scholar Symposium Abstracts and Posters

Range Anxiety is the fear of running out of fuel for your car before arriving at a refueling point or final destination. While usually absent or low in gas-powered vehicles, this anxiety is a salient consideration when buying electric vehicles (EVs). This and the fact that there are fewer charging stations available compared to gas stations have been offered as hypotheses for why EV sales are low. Previous research has found that those with more experience driving EVs, felt less range anxiety as they can when and where to charge their vehicle in their daily lives. EVs are more environmentally …

Measuring Neural Time Series Data In A Sensory Deprivation Tank, Jackson Gregory, Tian Lan, Uri Maoz, Amir Raz

Student Scholar Symposium Abstracts and Posters

We are interested in studying the neurological and physiological effects of the float pod, also known as REST therapy, or sensory deprivation tank. Float pods rely on the concept of depriving most senses (from sound and light to temperature and proprioception) in a pool filled with buoyant salt water at body temperature. While float pods are most commonly used in spa environments, we intend to look at the potential benefits of floating under the empirical lens. In this study, we aim to measure neural activity using electroencephalography (EEG). We intend to look at the different levels of relaxation and the …

Does It Matter Whether You Or Your Brain Did It? An Empirical Investigation Of The Influence Of The Double Subject Fallacy On Moral Responsibility Judgments, Uri Maoz, Kellienne R. Sita, Jeroen J. A. Van Boxtel, Liad Mudrik

Psychology Faculty Articles and Research

Despite progress in cognitive neuroscience, we are still far from understanding the relations between the brain and the conscious self. We previously suggested that some neuroscientific texts that attempt to clarify these relations may in fact make them more difficult to understand. Such texts—ranging from popular science to high-impact scientific publications—position the brain and the conscious self as two independent, interacting subjects, capable of possessing opposite psychological states. We termed such writing ‘Double Subject Fallacy’ (DSF). We further suggested that such DSF language, besides being conceptually confusing and reflecting dualistic intuitions, might affect people’s conceptions of moral responsibility, lessening the …

Parameterizing And Validating Existing Algorithms For Identifying Out-Of-Bed Time Using Hip-Worn Accelerometer Data From Older Women, John Belletierre, Yiliang Zhang, Vincent Berardi, Kelsie M. Full, Jacqueline Kerr, Michael J. Lamonte, Kelly R. Evenson, Melbourne Hovell, Andrea Z. Lacroix, Chongzhi Di

Psychology Faculty Articles and Research

Objective: To parameterize and validate two existing algorithms for identifying out-of-bed time using 24-hour hip-worn accelerometer data from older women. Approach: Overall, 628 women (80±6 years old) wore ActiGraph GT3X+ accelerometers 24 hours/day for up to 7 days and concurrently completed sleep-logs. Trained staff used a validated visual analysis protocol to measure in-bed periods on accelerometer tracings (criterion). The Tracy and McVeigh algorithms were adapted for optimal use in older adults. A training set of 314 women was used to choose two key thresholds by maximizing the sum of sensitivity and specificity for each algorithm and data (vertical axis, VA, …

Changing Healthcare Provider And Parent Behaviors In The Pediatric Post‐Anesthesia‐Care‐Unit To Reduce Child Pain: Nurse And Parent Training In Postoperative Stress (Np‐Tips), Brooke N. Jenkins, Michelle Fortier, Robert S. Stevenson, Mai Makhlouf, Paulina Lim, Remy Converse, Zeev N. Kain

Psychology Faculty Articles and Research

Background

Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain.

Methods

In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically‐based intervention which was then evaluated by experienced nurses (N = 8) and parents …

Delay Discount Rate Moderates A Physical Activity Intervention Testing Immediate Rewards, Christine B. Phillips, Jane C. Hurley, Siddhartha S. Angadi, Michael Todd, Vincent Berardi, Melbourne Hovell, Marc A. Adams

Psychology Faculty Articles and Research

Financial incentives can increase physical activity (PA), but differences in the immediacy of reward delivery and individual differences in delay discount rates (i.e., higher discount values associated with less tolerance for delayed rewards) may explain differential responding. The current study tested whether delay discount rate moderated the relative effectiveness of immediate financial rewards on increasing daily PA. Inactive, overweight adults (ages 18–60, N = 96) were randomized to receive either smaller, immediate goal-contingent rewards or larger, delayed rewards for participation. Delay discount rates were derived for those who completed the Monetary Choice Questionnaire (N = 85). Linear mixed models tested …

Oxytocin Receptor Gene (Oxtr) And Father Support Interact To Predict Depressive Symptoms Postpartum, Parambir Bhatti, Taylor Delaney, Michael Poulin, Jennifer Hahn-Holbrook

Psychology Faculty Articles and Research

Postpartum depression (PPD) is a debilitating mental illness affecting approximately 13% of mothers after birth. Both genetic and psychosocial factors contribute to PPD risk, but very little is known about how these factors interact. We tested whether the rs53576 polymorphism in the oxytocin receptor (OXTR) gene accounts for variation in the impact of low social support as a risk factor for depression among mothers during the perinatal period. New mothers (N = 220) provided saliva or blood DNA samples and completed surveys assessing PPD symptoms and perceived social support. In a significant interaction, social support from the …

Systematic Literature Review Of Quetiapine For The Treatment Of Psychosis In Patients With Parkinsonism, Jack J. Chen, Henry Hua, Lilian Massihi, Ivan Portillo, Azita Alipour, William Ondo, Khashayar Dashtipour

Library Articles and Research

Objective:

The purpose of this article was to determine the efficacy and tolerability of quetiapine compared with placebo or other interventions for psychosis in parkinsonism.

Methods:

Participants with a diagnosis of parkinsonism participated in randomized controlled trials (RCTs) investigating the efficacy and tolerability of quetiapine for psychotic symptoms within a defined follow-up period. The authors conducted searches on PubMed, Cochrane Controlled Register of Trials, and EMBASE for articles published from January 1991 to October 2017. Study methodology and patient- and treatment-level data were independently extracted and summarized by using descriptive statistics. Studies underwent quality assessment for risk of bias.

Results: …