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Walden Dissertations and Doctoral Studies

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Emotional Support In Managing Cardiovascular Diseases Among Hispanic And Non- Hispanic Menopausal Women, Claudette Andrea Jan 2011

Emotional Support In Managing Cardiovascular Diseases Among Hispanic And Non- Hispanic Menopausal Women, Claudette Andrea

Walden Dissertations and Doctoral Studies

Effective recognition and proper treatment of cardiovascular diseases (CVDs) in Hispanic woman is a public health problem that needs further investigation. Guided by the stress and coping social support theory, the purpose of this cross-sectional survey study was to examine the relationship between attitudes, emotional support, and the perception of success in managing cardiovascular diseases (CVDs) in 335 Hispanic women living in Atlanta, Georgia. Correlations, independent-sample t tests, simple linear regression, and multiple linear regressions showed ethnicity as a moderating variable between the perception of success in handling CVD and emotional support, while emotional support was shown to be a …


Learning Style Needs And Effectiveness Of Adult Health Literacy Education, Leah A. Grebner Jan 2011

Learning Style Needs And Effectiveness Of Adult Health Literacy Education, Leah A. Grebner

Walden Dissertations and Doctoral Studies

Low health literacy impacts an individual's ability to comprehend communication from healthcare providers, reduces access to healthcare, and contributes to increased mortality. The purpose of this study was to evaluate the impact of learning style on adult health literacy education. The health belief model, protection motivation theory, the transtheoretical model, and social cognitive theory were used to analyze the data in this study, and to further develop effective health literacy education. The research questions addressed the effectiveness of educational intervention adjusted to their appropriate learning style in comparison to a standardized health literacy intervention and potential difference, according to type …


Effect Of Education On Stigma Of Epilepsy In South Eastern Nigeria, Augustina Chinyelu Maduakor-Ugo Jan 2011

Effect Of Education On Stigma Of Epilepsy In South Eastern Nigeria, Augustina Chinyelu Maduakor-Ugo

Walden Dissertations and Doctoral Studies

There is a need for epilepsy-based health education programs to enlighten Nigerian communities and reduce the stigma associated with epilepsy. Epilepsy in Nigeria is viewed by some as a contagious and an infectious disease or a condition imposed from the gods, possessed by demons, as the work of witchcraft, or punishment from ancestral spirits, which are all related to a lack of knowledge about epilepsy leading to stigmatization of persons with epilepsy. Guided by the stigma theory, the purpose of this community-based, cross sectional study was to quantitatively examine the effect of an educational program on interpersonal, internalized, and institutional …


Leadership And Attitudes On Adopting Evidence-Based Practice For Influenza Vaccination, Pamela A. Paparone Jan 2011

Leadership And Attitudes On Adopting Evidence-Based Practice For Influenza Vaccination, Pamela A. Paparone

Walden Dissertations and Doctoral Studies

The United States has set a 90% benchmark for influenza vaccinations for healthcare personnel. Unfortunately, healthcare personnel fall far short of that mark with current rates as low as 62%. Low vaccination rates are responsible for influenza, nosocomial influenza, influenza-like illness, and mortality during influenza season. The purpose of this quantitative correlational study was to understand the relationship between leadership styles, attitudes towards evidence-based practice, and vaccination intention among New Jersey registered nurses (RNs). Diffusion of innovations theory was the theoretical foundation. The 3 instruments used were the Multifactor Leadership Questionnaire, Evidence Based Practice Attitude Scale, and Behavioral Intention Scales, …


The Impact Of Nutrition-Teaching Self-Efficacy On Daily Fruit And Vegetable Intake, Leslie E. Rawls Hoglund Jan 2011

The Impact Of Nutrition-Teaching Self-Efficacy On Daily Fruit And Vegetable Intake, Leslie E. Rawls Hoglund

Walden Dissertations and Doctoral Studies

Lack of fruit and vegetable (FV) consumption is directly linked to the prevalence of obesity and chronic disease in the United States. The USDA Fresh Fruit and Vegetable Program (FFVP) offers elementary school teachers access to healthy foods as part of the public school classroom experience. The purpose of this study---which was based on self-efficacy theory and the socio-ecological model---was to examine if an association exists between selected factors: (a) daily fruit and vegetable consumption, training status in the USDA Fresh Fruit and Vegetable Program (FFVP), and an established school nutrition policy and (b) nutrition-teaching self-efficacy (NTSE) among elementary school …


An Examination Of Awareness Of Over-The-Counter Nonsteroidal Anti-Inflammatory Drugs And Adverse Events, Michelle Popa Jan 2011

An Examination Of Awareness Of Over-The-Counter Nonsteroidal Anti-Inflammatory Drugs And Adverse Events, Michelle Popa

Walden Dissertations and Doctoral Studies

The elderly population is among the fastest growing populations in the United States. Finding and consuming medications safely and effectively are challenging endeavors for this population. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a widely consumed class of medications among the elderly population, with 70% of individuals consuming over-the-counter (OTC) NSAIDs once a week and 34% using them daily. The purpose of this quantitative study was to determine whether (a) patients are aware of the risks associated with the consumption of NSAIDs, and (b) there are differences in awareness based upon specific demographic characteristics and levels of patient-physician communication. The health belief …


Perspectives Of Women In Nairobi Kenya Toward Malaria Control, Catherine Kisavi-Atatah Jan 2011

Perspectives Of Women In Nairobi Kenya Toward Malaria Control, Catherine Kisavi-Atatah

Walden Dissertations and Doctoral Studies

Malaria infection has been and continues to be a serious public health concern that has mystified many in the public health care industry. One area in Sub Saharan Africa that continues to feel the devastating effects of malaria is in Nairobi, Kenya. This qualitative research study explored the attitudes of women in Nairobi, Kenya and how they view intervention measures already introduced by public health care experts in fighting malaria. The phenomenological research approach used purposeful sampling to recruit 16 women from Nairobi, Kenya to participate in semi-structured, open-ended interviews. The ecological systems theory was used as a lens of …


The Effect Of Breastfeeding On The Bmi Of Hispanic Preschool Children, Linda M. Kilby Jan 2010

The Effect Of Breastfeeding On The Bmi Of Hispanic Preschool Children, Linda M. Kilby

Walden Dissertations and Doctoral Studies

The American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding for the first 4-6 months of life to reduce risk of obesity in pre-school children. Previous research has indicated a high rate of obesity among Hispanic children in the northeastern United States. There is also a gap in the literature regarding the effectiveness of exclusive breastfeeding in preventing obesity among preschool Hispanic children. Therefore, the purpose of this study was to determine if there was an association between exclusive breastfeeding and obesity among pre-school Hispanic children enrolled in the Special Supplemental Nutrition Education Program for Women, Infants and …


Who Shares? Managerial Knowledge Transfer Practices In British Columbia's Ministry Of Health Services, Gwendolyn Elizabeth Lock Jan 2010

Who Shares? Managerial Knowledge Transfer Practices In British Columbia's Ministry Of Health Services, Gwendolyn Elizabeth Lock

Walden Dissertations and Doctoral Studies

The British Columbia government's Ministry of Health Services will experience significant loss of operational knowledge from an aging managerial workforce, increased staff turnover, and difficulties in recruitment. The purpose of this study is to provide the ministry's Strategic Human Resources Planning branch staff with a map and description of knowledge transfer practices used by approximately 40 managers within the ministry's Health Sector Information Management/Information Technology division and its Vital Statistics Agency. The study is a mixed-methods case study of knowledge retention and transfer practices founded on a knowledge management and social network theoretical foundation. To understand the ministry's complex nature …


Racial /Ethnic Differences In Susceptibility And Intention To Smoke On Smoking Behavior Among Adolescents, Kafilat Tolani Jimba Jan 2010

Racial /Ethnic Differences In Susceptibility And Intention To Smoke On Smoking Behavior Among Adolescents, Kafilat Tolani Jimba

Walden Dissertations and Doctoral Studies

Every year, more than 400,000 Americans die prematurely because of tobacco use, and most users began smoking during their teen years. Adolescent tobacco use remains the nation's most preventable threat to life and health. A better understanding of the relationships between susceptibility to smoking and intention to smoke on smoking behavior by ethnicity, age, and gender is useful for program planners and health educators in designing ethnic, age, and gender specific strategies for tobacco control and prevention initiatives. The purpose of this study was to test the relationships between susceptibility to smoking and intention to smoke on smoking behavior among …


The Relationship Between Leadership Styles And Performance Success In Hospitals, Beverly J. D. Hernandez Jan 2010

The Relationship Between Leadership Styles And Performance Success In Hospitals, Beverly J. D. Hernandez

Walden Dissertations and Doctoral Studies

Upheavals in the health care landscape threaten the sustainability of contemporary hospital organizations. Yet there is limited research regarding the characteristics of leaders within successful hospitals. The problem is the leadership styles needed to effectively run hospital organizations have not been identified and/or established. The purpose of this study was to develop a model of congruent leadership styles linked to the success of hospitals in one metropolitan city. The research questions sought to uncover (a) consistent leadership styles within successful hospitals, and (b) what, if any, relationship exists between leadership styles and measures of success. Examination of the literature uncovered …


The Mediating Role Of Psychological Distress In The Relationship Between Adverse Childhood Experiences And Adult Smoking, Tara Wynn Strine Jan 2010

The Mediating Role Of Psychological Distress In The Relationship Between Adverse Childhood Experiences And Adult Smoking, Tara Wynn Strine

Walden Dissertations and Doctoral Studies

While research has indicated that impaired mental health partially mediates the relationship between adverse childhood experiences (ACEs) and alcohol and illicit drug use, little research has examined potential mediators in the relationship between ACEs and smoking, the number one cause of preventable mortality in the United States. Accordingly, this study examined the potential mediating effect of psychological distress on the relationship between ACES and smoking using data from Wave II of the ACE Study, a cross-sectional study completed between June and October of 1997 on a sample of adult health maintenance organization members (N = 7,211). The theoretical underpinnings for …


Immigration And Obesity In African American Adults Residing In The United States, Julius N. Ade Jan 2010

Immigration And Obesity In African American Adults Residing In The United States, Julius N. Ade

Walden Dissertations and Doctoral Studies

Obesity increases risk for heart disease, hypertension and other chronic diseases, and it affects minority ethnic groups disproportionately. However, it is unknown if African American immigrant adults, an increasing segment of the population, are at higher risk for obesity than African American non-immigrant adults residing in the United States. This study examined the association of obesity and immigrant status by comparing African American immigrant adults now residing in the United States to the general population of African American adults. The socio-ecological model provided the conceptual framework for this study. This study used a cross-sectional quantitative self-administered web-based survey to collect …


The Use Of Human Patient Simulators To Enhance The Clinical Decision Making Of Nursing Students, Sharon Kay Powell-Laney Jan 2010

The Use Of Human Patient Simulators To Enhance The Clinical Decision Making Of Nursing Students, Sharon Kay Powell-Laney

Walden Dissertations and Doctoral Studies

One of the newest teaching modalities in nursing education is the use of human patient simulators (HPS). An HPS simulation scenario creates a software program vignette in which students interact with a manikin to practice caring for critical patients in a risk-free environment. Although used extensively in schools of nursing, there is little research that examines if these expensive simulators improve the clinical decision-making ability of nursing students. The purpose of this experimental differentiated treatment study was to assess if HPS technology leads to increased clinical decision-making ability and clinical performance more than the teaching modality of a paper and …


Social Capital Variables As Predictors Of Hiv Risk-Taking Behaviors Among Sub-Saharan African Immigrants In The United States, Gbadebo Ogundiran Ogungbade Jan 2010

Social Capital Variables As Predictors Of Hiv Risk-Taking Behaviors Among Sub-Saharan African Immigrants In The United States, Gbadebo Ogundiran Ogungbade

Walden Dissertations and Doctoral Studies

Vulnerable populations, including immigrants, are often at risk for human immunodeficiency virus (HIV) infection because of their risk-taking behaviors. This study investigated risk-taking behavior for HIV infection among Sub-Saharan African (SSA) immigrants in United States. Using social capital as a theoretical foundation, the study aimed to address the question, is there any association between social capital assets of educational opportunity, employment, and eligibility for social assistance and HIV risk-taking behavior, defined as condom use before sex (CUBS) among SSA immigrant in the U.S? Potential participants were recruited through religious and social organizations in a southwestern US state. The survey generated …


The Effect Of Direct Contact On Public Attitudes Towards People Living With Human Immunodeficiency Virus (Hiv) And Acquired Immune Deficiency Syndrome (Aids) In Zimbabweans, Mavis Mashingaidze Jan 2010

The Effect Of Direct Contact On Public Attitudes Towards People Living With Human Immunodeficiency Virus (Hiv) And Acquired Immune Deficiency Syndrome (Aids) In Zimbabweans, Mavis Mashingaidze

Walden Dissertations and Doctoral Studies

Stigma surrounding HIV and AIDS poses a significant threat to the curtailing of the epidemic by acting as a barrier to HIV testing and disclosure of serostatus. Previous research in the United States found personal knowledge of someone with HIV/AIDS to be a predictor of lower levels of HIV/AIDS-related stigma. However, no study to date has examined this relationship in Zimbabweans. Allport's contact hypothesis was hypothesis was the theoretical frame used to assess the effect of direct contact on public attitudes towards people living with the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in Zimbabweans with the …


Clinical Recognition Of Obstructive Sleep Apnea In A Population-Based Sample, Mark R. Zellmer Jan 2010

Clinical Recognition Of Obstructive Sleep Apnea In A Population-Based Sample, Mark R. Zellmer

Walden Dissertations and Doctoral Studies

Obstructive sleep apnea (OSA), a disorder in which the airway intermittently collapses and obstructs during sleep, is associated with increased cardiovascular and cerebrovascular morbidity and mortality, increased risk of motor vehicle accidents, metabolic syndrome, hypertension, and depression. Treatment of OSA attenuates or reverses many of these associated risks. However, most cases of OSA are unrecognized and untreated. The two most recent studies using 1990s data found that only 6.5 - 15.4% of OSA cases, depending on severity, are clinically recognized in mixed gender populations. Based on a conceptual framework of improved physician awareness of OSA, and reduced diagnostic access bias …


Risk Factors For Development Of High Blood Pressure And Obesity Among African American Adolescents, Monique Shanta White Jan 2010

Risk Factors For Development Of High Blood Pressure And Obesity Among African American Adolescents, Monique Shanta White

Walden Dissertations and Doctoral Studies

Childhood obesity has reached epidemic proportions in the United States and has been linked to hypertension, especially among African American youth. Optimistic bias leads youth to underestimate their susceptibility to negative health outcomes. Public health officials want to reduce risk factors to result in significant long term reduction in cardiovascular disease. The purpose of this study was to explore adolescent behavior practices in a school district and prevalence of high blood pressure and obesity in that population. The health belief model guided the framework for this study. Research questions examined relationship between individual health risk practices and optimistic bias on …


Racial /Ethnic Disparities In Hypertension In United States Residents: A Cross-Sectional Study Of Potential Explanatory Covariates, Franklin I. Opara Jan 2010

Racial /Ethnic Disparities In Hypertension In United States Residents: A Cross-Sectional Study Of Potential Explanatory Covariates, Franklin I. Opara

Walden Dissertations and Doctoral Studies

Racial/ethnic disparities persist in hypertension (HTN) prevalence in the United States, and African Americans are disproportionately affected. The incidence is more than two-folds in African Americans compared to Caucasians, and mortality is highest among African Americans. Understanding the risk factors in HTN and how these factors vary across racial/ethnic groups is essential to reducing the mortality among African Americans. This study examined the prevalence of HTN among a sample non-institutionalized U.S. residents (N = 30,852), assessed racial/ethnic disparities and determined factors associated with racial/ethnic variance in HTN. A cross-sectional design was used to address these aims, utilizing the National Health …


Manual Handling Workload And Musculoskeletal Discomfort Among Warehouse Personnel, Terrance N. Knox Jan 2010

Manual Handling Workload And Musculoskeletal Discomfort Among Warehouse Personnel, Terrance N. Knox

Walden Dissertations and Doctoral Studies

Work-related musculoskeletal disorders (WRMSD), specifically physical and muscular discomfort in the upper arm, lower arm, thigh, lower leg, wrist, shoulders, back, or neck, are among the most frequently reported workplace injuries in the United States. The dearth of knowledge about the types of workloads that may contribute to the development of WRMSD was the impetus of this research. The study aimed to identify antecedents of WRMSD among warehouse workers in order to reduce WRMSDs and increase productivity as expressed in a systems perspective on industrial health. The research questions examined the prevalence of specific WRMSDs, the relationship of high-risk tasks …


Knowledge, Attitudes, And Behaviors Of African American Women Regarding Breast Cancer Screening, Lilian Uwuseba Jan 2010

Knowledge, Attitudes, And Behaviors Of African American Women Regarding Breast Cancer Screening, Lilian Uwuseba

Walden Dissertations and Doctoral Studies

Breast cancer is one of the most widespread chronic diseases and a major cause of death among women in the United States. African American women have a higher incidence of breast cancer than their counterparts from other ethnic/racial groups. The purpose of this cross-sectional survey of 126 African American females from the western US metropolitan area was to assess knowledge, attitudes, and behavior with respect to breast cancer manifestation, detection services, and the role of mammography in breast cancer prevention and control. The health belief model guided this study. A 41-item, ethnically sensitive, self-administered, and gender-specific instrument, the Champion Revised …


Understanding Middle School Students' Perspectives Regarding Physical Activity And Fitness, Susan Yesalonia Jan 2009

Understanding Middle School Students' Perspectives Regarding Physical Activity And Fitness, Susan Yesalonia

Walden Dissertations and Doctoral Studies

Research confirms inactivity increases in adolescence and that unfit youth are at risk of acquiring cardiovascular diseases, diabetes, obesity, or other significant physical disorders later in life. Thus, the purpose of this phenomenological study was to describe the experience of chronically inactive children who were exposed to an exercise intervention program. The specific focus of the research was to better understand the essential educational needs of the participants and the effective elements of the program, Moving for Fun (MFF), a 7-week after-school fitness intervention program designed to modify chronic inactivity. Open-ended interviews and 3 observations were conducted with 8 middle …


A Comparison Of Lifestyle Intervention Sessions And Clinical Screening As Motivators In The South Dakota Wisewoman Program, Jacy Clarke Jan 2009

A Comparison Of Lifestyle Intervention Sessions And Clinical Screening As Motivators In The South Dakota Wisewoman Program, Jacy Clarke

Walden Dissertations and Doctoral Studies

WISEWOMAN (WW) is a comprehensive program for medically underserved women in South Dakota (SD), aged 30 to 64, which aims to reduce morbidity and mortality from chronic diseases. Screening services include blood total cholesterol, blood pressure and blood glucose, and body mass index (BMI). Lifestyle intervention (LSI) sessions are also offered to address physical activity and nutrition. The purpose of this retrospective longitudinal study was to quantitatively examine whether the combination of LSI's and clinical screenings or clinical screenings alone lead to improvements in blood pressure, blood glucose, total cholesterol, and/or BMI at rescreening 10 to14 months from initial screening. …


Promoting Breast Cancer Screening Among Chinese American Women Through Young Children's Theatrical Performance, Angela Sun Jan 2009

Promoting Breast Cancer Screening Among Chinese American Women Through Young Children's Theatrical Performance, Angela Sun

Walden Dissertations and Doctoral Studies

Research has revealed that underutilization of breast cancer screening by ethnic minorities often is related to language difficulties and cultural values and beliefs about cancer. The problem addressed in this secondary data analysis was the late diagnosis of breast cancer in the Chinese immigrant community. The purpose of the quasi-experimental study was to test the efficacy of a theatrical preschool performance, guided by the diffusion of innovation theory, in educating Chinese American women about breast cancer detection. The research questions sought to determine whether the performance increased the participants' knowledge of breast cancer screening guidelines and whether country of origin, …


Foodborne Or Pandemic: An Analysis Of The Transmission Of Norovirus-Associated Gastroenteritis And The Role Of Food Handlers, M. S. Dreyfuss Jan 2009

Foodborne Or Pandemic: An Analysis Of The Transmission Of Norovirus-Associated Gastroenteritis And The Role Of Food Handlers, M. S. Dreyfuss

Walden Dissertations and Doctoral Studies

This study examined the strength of association between food workers and food to norovirus in comparison to bacteria associated with foodborne-related gastroenteritis by whether norovirus had a direct (physical evidence), indirect (statistical evidence), or suspect (neither of the two) association with food or food handlers. The Centers for Disease Control and Prevention considers norovirus to cause the largest number of foodborne-related gastroenteritis cases in the United States. The association of norovirus with foodborne outbreaks through its information data collection form focuses on the food worker as the typical source. Yet, many outbreaks are not foodborne in nature. The gap in …


Beliefs And Attitudes Regarding Health -Enhancing Behaviors In African American And Caucasian Women, Cassaundra Murray Jan 2009

Beliefs And Attitudes Regarding Health -Enhancing Behaviors In African American And Caucasian Women, Cassaundra Murray

Walden Dissertations and Doctoral Studies

A disproportionate number of African American (AA) women are overweight, obese, and more likely to have weight related health concerns compared with Caucasian (C) women. Previous research indicates perception about health-enhancing behaviors influences AA females' health behavior. A gap exists in the current literature regarding AA women's perception of eating and exercise behavior and the impact social support has on AA women's adherence to USDA recommendations. The purpose of this study was twofold: (1) to examine AA women's weight locus of control, perceived susceptibility to weight related diseases, and perceived barriers to healthy eating and exercise relative to C women; …


The Lived Experience Of Hiv-Positive Tanzanian Orphans, Carol A. Parker Jan 2009

The Lived Experience Of Hiv-Positive Tanzanian Orphans, Carol A. Parker

Walden Dissertations and Doctoral Studies

The purpose of this investigation was to generate a context- specific model of the lived experience of HIV positive Tanzanian orphans. With the advent of anti-retroviral drugs, Sub-Saharan African populations with high burdens of human immunodeficiency virus (HIV) face annually accumulating increases in the number of HIV positive children, and ultimately adults. Perinatally infected, these children often become orphans while still young. Extended interviews were performed with a purposive sample of 12 HIV infected orphaned children between 9 and 12 years of age. Half of the research participants lived in an orphanage and half were children living with guardians in …


Intrapersonal And Community-Related Influences Of Rural Adolescent Pregnancy: A Mixed-Method Approach, Kimberly Becknel Brodie Jan 2009

Intrapersonal And Community-Related Influences Of Rural Adolescent Pregnancy: A Mixed-Method Approach, Kimberly Becknel Brodie

Walden Dissertations and Doctoral Studies

The majority of data on adolescent pregnancy pertains to urban communities, therefore, the individual and social influences associated with adolescent pregnancy in rural communities have not been extensively explored. The pregnancy rate among adolescent women aged 15 to 19 in rural Vance County, North Carolina, is 113.7 per 1,000, nearly twice the state average. This sequential mixed-method study used the social ecological model to evaluate the intrapersonal and community-related factors associated with adolescent pregnancy in this rural area. A quantitative survey assessed intrapersonal factors, namely sexual health knowledge, sex-related attitudes, and self-esteem in pregnant or parenting and nonpregnant or nonparenting …


The Responses Of Bamenda Disability Organizations To Hiv And Aids: A Multiple Case Study, Lynn Cockburn Jan 2009

The Responses Of Bamenda Disability Organizations To Hiv And Aids: A Multiple Case Study, Lynn Cockburn

Walden Dissertations and Doctoral Studies

In Cameroon, many disabled people (an estimated 10-20% of the population) have inadequate access to education and health care, and disabled people's organizations (DPOs) are advocating for social change. Yet, there is a scarcity of information regarding how African DPOs address HIV and AIDS. The purpose of this study was to assess how DPOs in Cameroon have responded to AIDS in the disabled population and to identify strategies to enable DPOs to manage AIDS issues. This study was guided by the complex adaptive systems theory as the theoretical framework. The research questions focused on what DPOs have done to develop …


Prognostic Factors Of Varying Treatment Outcomes For Onychomycosis (Nail Fungal Infection) Patients, Bin Cai Jan 2008

Prognostic Factors Of Varying Treatment Outcomes For Onychomycosis (Nail Fungal Infection) Patients, Bin Cai

Walden Dissertations and Doctoral Studies

Prevalence of onychomycosis, as high as 26.9% in the general population, can be reduced by improving current antifungal treatment. This could be accomplished by understanding prognostic factors, especially healthy nail growth, associated with achieving complete cure. This population-based study aimed to evaluate if healthy nail length or percentage of total full nail length as healthy can be early indictors for complete cure. Logistics regression analyses were performed by comparing variables between a population who achieved the complete cure and a population who failed after both populations received the same antifungal treatment in two large randomized double-blinded clinical trials that assessed …