http://dx.doi.org/10.24016/2024.v10.424
ORIGINAL ARTICLE
Psychometric properties comparison among diverse versions of the
invalidation childhood environmental scale (ICES) in Peruvian adults
Comparación de propiedades psicométricas de diversas versiones de la
escala de ambiente invalidante infantil (ICES) en adultos peruanos
Alvaro Okumura-Clark 1*,
Jesus Blancas-Guillen 1, Leandra Ccoyllo-Gonzalez 1, Pablo D. Valencia 2
1 Instituto Peruano de
Psicología Contextual – Dirección Valiosa, Lima, Peru
2 Facultad de Estudios
Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico.
*
Correspondence: alvaro.okumura.c@gmail.com
Received: June 24, 2024 | Revised: August 04, 2024 | Accepted: September 8, 2024 | Published Online: September 11, 2024
CITE IT AS:
Okumura-Clark,
A., Blancas-Guillen, J., Ccoyllo-Gonzalez, L., & Valencia, P. D. (2024). Psychometric
properties comparison among diverse versions of the invalidation childhood
environmental scale (ICES) in Peruvian adults. Interacciones,
10, e424. http://dx.doi.org/10.24016/2024.v10.424
ABSTRACT
Introduction: The current
tendency regarding psychometric assessment is to use brief versions of
measurement tools. Objective: The
present study sought to compare the psychometric properties of various versions
in the length of the Invalidating Children Environment Scale (ICES). Method: Three hundred and twelve
Peruvian university students participated as a sample. Confirmatory factor
analysis was performed, and internal consistency was considered the reliability
method. Results: The proposal with
the best-fit indices was the brief version with nine items compared to the
original version (14 items). Adequate internal consistency coefficients were
determined for the scale factors. Finally, convergent and divergent validity
were obtained through significant associations with the constructs of anxiety
and depression. Conclusion: Various
versions of the ICES comply with current psychometric standards, and the brief
version of nine items is the most recommended.
Keywords: Invalidating Children
Environment Scale (ICES), psychometric properties comparison, Peruvian adults,
validity, reliability.
RESUMEN
Introducción: La tendencia actual a nivel de la evaluación psicométrica consiste en
el uso de versiones breves de herramientas de medición. Objetivo: El presente estudio buscó comparar las propiedades
psicométricas de diversas versiones en extensión de la Escala de Ambiente
Invalidante Infantil (ICES). Método: Trescientos
doce estudiantes universitarios peruanos participaron como muestra. Se utilizó
el análisis factorial confirmatorio y la consistencia interna fue considerada
como método de confiabilidad. Resultados:
Se determinó que la propuesta con mejores índices de ajuste fue la versión
breve de nueve ítems en comparación a la versión original (14 ítems). Adecuados
coeficientes de consistencia interna fueron determinados para los factores de
la escala. Finalmente, evidencias de validez convergente y divergente fueron
obtenidas a través de asociaciones significativas con los constructos de
ansiedad y depresión. Conclusiones: Existen
diversas versiones del ICES que cumplen con los estándares psicométricos
actuales y siendo aquella más recomendada la versión breve de nueve ítems.
Palabras claves: Escala de Ambiente Invalidante Infantil (ICES),
comparación de propiedades psicométricas, adultos peruanos, validez,
confiabilidad.
Invalidating environments (IE) offer minimization, trivialization, and
extreme responses regarding an individual's emotional, cognitive, and
behavioral responses (Linehan, 1993). IE is characterized by (a) expressive
rejection of private experiences through extinction (i.e., non-reinforcement)
and blocking principles (i.e., punishment, criticism), (b) intermittent
reinforcement of more high-intensity emotional expressions and patterns’
perpetuation consequently, and (c) problems’ oversimplification through supposedly
easy solutions (Boggiano & Gagliesi, 2020).
IE between childhood and adolescent stages generates a
series of repercussions on mental health and associates. Various
psychopathologies are developed consequently, usually underlying a key factor
denominated as emotional dysregulation (Linehan et al., 2007). In that sense,
depression (Boring et al., 2021), anxiety (Ramírez & Espinoza, 2021),
borderline personality disorder (Keng & Soh, 2018), low self-esteem and
self-compassion (Keng & Wong, 2017; Bontempo, 2022) and lower quality and
satisfaction with life (Elzy, 2013; Stefanatou et
al., 2022) are examples of this dynamic, being highly identified in the current
scene. On the contrary, validating environments promote support and a more
disposition toward one's emotional repertoires, promoting healthier individual
development (Stoewsand, 2021). These contexts are
beneficial in promoting cognitive-emotional expression, freedom, and
acceptance, as well as situationally flexible and functional repertoires (Hopko
et al., 2003; Koerner, 2012).
Certain variables that may contribute to invalidating
environments have been identified in the Peruvian context. In that sense,
different stressors can be noticed, usually associated with interpersonal
relationships, economic issues, and public safety difficulties (Cassaretto et al., 2021). These stressors affect college
students, especially when they become responsible for their own expenses. The
academic demands, schedules, and pre-professional practices also increase
discomfort. Since this population could be considered a vulnerable community,
lacking adequate emotion regulation and distress tolerance skills is highly
prevalent, increasing their emotional difficulties and promoting the
invalidation of other people's emotional responses (Boggiano & Gagliesi, 2020).
To analyze such prevalent constructs, the Invalidating
Childhood Environment Scale (ICES) was initially developed by Mountford et al. (2007) to evaluate the retrospective
interaction perceptions that the adults had with both parents during childhood
and adolescent stages, considering Linehan's (1993) conceptualization of IE.
Evidence of convergent and discriminant validity was preliminarily obtained,
but other relevant psychometric properties were not identified to determine the
internal structure of the test (AERA et al., 2014; Mountford
et al., 2007).
Various studies were developed to determine the
psychometric properties of the ICES. In this sense, Alpay et al. (2018)
developed a Turkish version, in which a unifactorial structure was proposed
through confirmatory factor analysis with acceptable fit indices for both
parental figures and internal consistency coefficients within expected.
Regarding this adaptation, although statistical results were obtained according
to current standards, not discerning patterns of invalidation-validation would
not allow the detailed diagnosis of the interactions between the child and their
parents. Along the same lines, Robertson et al. (2013) opted to eliminate five
items (all belonging to the validating environments factor) to improve the fit
of the instrument. The adjustment indices significantly enhanced for both
parental dimensions based on such conditions.
Secondly, the same dynamic is visualized in Alpay et
al.’s adaptation. (2018) by not considering the components of validating
responses from both parents. Finally, in a recent adaptation, Holden et al.
(2021) stipulated an internal three-factor structure, considering maternal
invalidation (items 1, 10, 11, and 13), paternal active invalidation (items 4,
7, 10, and 11), and paternal passive invalidation, which considers the items
with reversed scoring (items 5, 8, 12 and 14). Certain aspects of this study need
improvement, mainly in conceptualizing passive
invalidating responses. When considering validity evidence based on content
from that dimension, the items primarily focus on the assessment of supportive
environments (validating responses) from both parents, according to Mountford et al. (2007). In other words, considering
passive invalidating responses as validating repertoires does not have much
coherence at a conceptual level.
As a complement, recent Latin American proposals have
been developed to avoid these previously mentioned methodological aspects (Puddington et al., 2017; Puddington
et al., 2022; Okumura-Clark et al., 2023), determining a clear two-factor
structure for each parent (validating and invalidating responses). Although
successful results have been identified, current trends emphasize the relevance
of constructing much shorter tests for assessment and research aims (Sleep et
al., 2021).
Under these premises, the adaptation of the ICES is
highly relevant, in addition to identifying possible brief versions of this
exact instrument, considering that this test responds to needs at the clinical
assessment level. Therefore, this research aims to determine the psychometric
performance of various reduced versions of the Invalidating Childhood
Environment Scale (ICES) in Peruvian samples.
METHODS
Design
Our study was cross-sectional.
Participants
Non-probabilistic convenience sampling was used for
this study. The final sample
consisted of 312 psychology college students from Peru, aged 18 to 48 years
(M=22.38, SD=5.03). First, most participants reported female when asked regarding
biological sex (71.2%.). As regarding gender, participants self-identified as
females (69.6%), males (28.5%), non-binary (1.6%), or preferred not to disclose
(0.3%). The majority identified as heterosexual (86.2%). Most participants were
from Lima, the capital of Peru (96.8%). The
prevalence of anxiety and depression symptoms was 25.6% and 26.0%,
respectively, based on established cut-offs of our self-report measures.
To determine the sample size, the calculator proposed
by Kim (2005) for structural equation models was used. In the extensive version
of the test, considering a CFI of .95, two factors composed of 10 and 4 items,
respectively, an estimated average factor loading of .65, a latent compression
of .60, and a power of 80%, it was estimated a minimum sample size of 183
participants. The exact estimators were considered for its brief version,
except for the items per factor (5 and 4, respectively) and the estimated
factor loading (.70), with the recommended minimum number of 181 participants.
Measurements
Sociodemographic record. Data such as
biological sex, gender, age, sexual orientation, and province of origin were
requested.
Invalidating Childhood Environment Scale (ICES). It was initially created by Mountford et al.
(2007) to assess the retrospective adult’s perception of validating and
invalidating responses from both parents (mother and father) during the
formative years (0-18 years of age). It was later Spanish adapted by Puddintong et al. (2017), and years later, a Peruvian
adaptation was developed (Okumura-Clark et al., 2023). It comprises 14 items
for each parent and 5 Likert scale alternative responses (1=Never, 5=All the
time). Several studies have identified the internal structure of the test
composed of two dimensions (parental’s validating and invalidating responses).
Adequate internal consistency coefficients were identified in the Peruvian
adaptation (ω = .85 - .87) (Okumura-Clark et al., 2023).
Patient Health Questionnaire-2 item (PHQ-2). This test is a reduced version of PHQ-9, composed of two items that
measure vital components of depressive symptomatology experienced over the last two weeks. Each item can be answered with
four alternative responses (0=Not all, 3=Nearly every day). An adequate
internal consistency coefficient has been identified in the derived scores
obtained in Peruvian college samples (α = .80) (Caycho-Rodriguez et al., 2020).
In systematic review studies, the sensitivity and specificity of the test have
been identified as exceeding 60%, leading to its recommendation for determining
depressive symptoms (Varela Chávez & Guayusamin Tipanta, 2023). Meta-analytic data suggest that a cutoff
score of ≥ 3 yields acceptable sensitivity (approximately .72–.76) and
specificity (approximately .85–.87) (Levis et al., 2020; Manea et al., 2016).
Generalized Anxiety Disorder Scale-2 (GAD-2). This test is a reduced version of GAD-7, composed of
two items that assess the main anxiety symptoms over the last two weeks. A
4-option Likert response has been considered (0=Not at all, 3=Nearly every
day). An acceptable internal consistency coefficient has been obtained in
Peruvian samples (ω = .81) (Baños-Chaparro, 2022). In its extended version,
high levels of sensitivity (73.3%) and specificity (67.3%) have been identified
(Zhong et al., 2015). According to an international meta-analysis, the GAD-2
with a cutoff score of ≥ 3 has a sensitivity of .76 and a specificity of .81
(Plummer et al., 2016).
Procedure
Data collection was facilitated using a digital format
(Google Forms), conducted within academic settings, and in collaboration with a
private Peruvian university and its faculty members. The application process
required 10 to 15 minutes per participant. All the data was collected in
September 2023.
It should be noted that participants in this study
were undergraduate students from a university located in the southern zone of
Lima, Peru. This county is known for its working-class population and has a
history of community-driven development despite economic challenges.
Data analysis
First, a series of confirmatory factor analyses were
conducted using the WLSMV method to
test the following models: (a) the original unidimensional 14-item model, (b)
the 14-item two-factor model proposed by Puddington
et al. (2017), and (c) the reduced two-factor model proposed by Okumura-Clark
et al. (2023). The fit was assessed through the following approximate indices:
Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root-Mean-Square Error
of Approximation (RMSEA) and Standardized Root-Mean-Squared Error (SRMR).
Following the usual guidelines, values of CFI > .95, TLI > .95, RMSEA
< .06, and SRMR < .08 would indicate a good fit (Hu & Bentler, 1999).
Consistency reliability was examined using the categorical omega coefficient
(Green & Yang, 2009). Likewise, the possibility of proposing a brief
version based on inspecting the factor structure was
examined. Finally, evidence of associative validity was examined through
Spearman correlations with anxiety and depression scores.
Ethical aspects
At first, a macro-research proposal was developed to
analyze the associations between early experiences related to a person’s
development, emotion regulation transdiagnostic variables, and mental health
components, which considered the psychometric analysis of the measurements as a
previous research step. This proposal was revised and later approved by the
research ethics commission of the Dirección
de Investigación de la Escuela de Psicología de la
Universidad Autónoma del Perú in June 2023.
During the preliminary testing phase, informed consent was employed, outlining
the aim of the study and ethical principles, including confidentiality,
anonymity, and voluntary participation. All participants accepted and signed
the informed consent to participate in the study.
RESULTS
Confirmatory Factor Analyses
The unidimensional model was first tested on the Mother Scale. As
presented in Table 1, the model fit was unacceptable. Puddington
et al.’s (2017) two-factor model performed slightly better, but the fit was
still mediocre. On the other hand, Okumura-Clark et al.’s (2023) reduced model had a notably better fit.
Examination of the modification indices revealed that allowing the errors of
items 1 (“My mother would become angry if I disagreed with her”) and 11 (“My
mother would explode with anger if I made decisions without asking her first”)
to correlate would increase model fit. Since this modification made conceptual
sense (both items referred to reactions of anger), it was added to the model.
The final model had an excellent fit (Table 1).
Table 1. Confirmatory
Factor Analysis Fit Indices of the Models Under Study
|
Scale |
Model |
χ² |
df |
p |
CFI |
TLI |
RMSEA |
SRMR |
|
Mother
Scale |
1. Unidimensional |
970.8 |
77 |
<.001 |
0.82 |
0.79 |
0.20 |
0.12 |
|
2. Puddington
et al.’s (2017) two-factor model |
591.5 |
76 |
<.001 |
0.90 |
0.88 |
0.15 |
0.15 |
|
|
3. Okumura-Clark et
al.’s (2023) two-factor model |
146.2 |
53 |
<.001 |
0.98 |
0.98 |
0.08 |
0.05 |
|
|
4. Model 3 + Correlated
errors (items 1 & 11) |
106.6 |
52 |
<.001 |
0.99 |
0.98 |
0.06 |
0.04 |
|
|
5. Proposed 9-item
short version |
45.7 |
26 |
0.01 |
1.00 |
0.99 |
0.05 |
0.03 |
|
|
Father
Scale |
1. Unidimensional |
922.3 |
77 |
<.001 |
0.84 |
0.82 |
0.22 |
0.18 |
|
2. Puddington
et al.’s (2017) two-factor model |
439.6 |
76 |
<.001 |
0.93 |
0.92 |
0.15 |
0.11 |
|
|
3. Okumura-Clark et
al.’s (2023) two-factor model |
216.7 |
64 |
<.001 |
0.97 |
0.96 |
0.10 |
0.07 |
|
|
4. Model 3 without item
2 |
124.9 |
53 |
<.001 |
0.99 |
0.98 |
0.08 |
0.05 |
|
|
5. Model 4 + Correlated
errors (items 1 & 11) |
108.0 |
52 |
<.001 |
0.99 |
0.99 |
0.07 |
0.05 |
|
|
6. Proposed 9-item
short version |
43.4 |
26 |
0.017 |
1.00 |
0.99 |
0.05 |
0.04 |
Note. All the
analyses were conducted using the WLSMV estimator.
As to the Father Scale, the unidimensional and Puddington
et al.’s (2017) model showed a mediocre fit, as expected. Similarly, Okumura-Clark et al.’s (2023) model also had a sub-optimal fit for this
scale. Modification indices revealed that item 2 (“When I was anxious, my
father ignored this”) was problematic since it required a cross-loading to be
added. After dropping this item, the fit improved. Modification indices showed
that allowing items 1 and 11 to correlate would also improve model fit for the
Father Scale, so we decided to add it to the model (Table 1). As can be seen in
Figures 1A and 2A, the final models were identical for both scales.
Development of a Short Version
To achieve a more economical version of the ICES, we iteratively dropped
items so that no correlated errors were included and only the most considerable
factor loadings remained. We also kept the same items in both scales: 4, 6, 7,
10, and 13 (invalidating behaviors) and 5, 8, 12, and 14 (validating
behaviors). Both short versions had an excellent fit (Table 1). They are
visually presented in Figures 1B and 2B.
Figure 1. Long and Short Version of the ICES Mother Scale.
Note. Standardized coefficients are presented. For simplicity, error
terms are not displayed.
Figure 2. Long and Short Version of the ICES Father Scale.
Note. Standardized coefficients are presented. For simplicity, error
terms are not displayed.
Internal Consistency Reliability
In the Mother Scale’s final long model (Figure 1A), internal consistency
reliability was estimated to be adequate both for invalidating (ω = .88) and validating
behaviors (ω = .86). Reliability was
nearly identical for the short version of the Mother Scale (ωinvalidating = .88, ωvalidating = .86). Similarly, the Father Scale’s extended
version (Figure 2A) had excellent reliability for the invalidating subscale (ω = .92), and excellent
reliability for the validating dimension (ω = .87). The short version of the Father Scale also
had excellent internal consistency reliability (ωinvalidating = .93, ωvalidating = .87).
Association with Anxiety and Depression
Table 2 displays the latent correlations between the ICES scales (as
well as their short versions) and two variables relevant to psychopathology:
anxiety and depression. It can be seen that invalidating behaviors (both from
the mother and the father) are associated with higher psychopathology. Also, to
a lesser extent, validating behaviors are related to less psychopathology. It
can also be seen that short versions perform similarly to the lengthier ones,
even though some evidence of attenuation is observed.
Table 2. Correlations
of Long and Short Versions of the ICES with Anxiety and Depression.
|
Scale |
Long Version |
Short Version |
||
|
|
Anxiety |
Depression |
Anxiety |
Depression |
|
Mother
scale |
||||
|
Invalidating
behaviors |
.27 [.15, .39]*** |
.37 [.25, .50]*** |
.24 [.11, .36]*** |
.31 [.19, .44]*** |
|
Validating
behaviors |
-.13 [-.25, -.01]* |
-.17 [-.31, -.04]* |
-.13 [-.25, -.01]* |
-.17 [-.30, -.04]* |
|
Father
scale |
||||
|
Invalidating
behaviors |
.26 [.11, .42]** |
.27 [.11, .42]** |
.25 [.09, .41]** |
.25 [.09, .41]** |
|
Validating
behaviors |
-.21 [-.37, -.05]* |
-.18 [-.33, -.02]* |
-.21 [-.37, -.05]* |
-.18 [-.33, -.02]* |
Note. The
estimations were obtained from structural equation models. 95% CI is
presented in brackets.
*p
< .05. **p < .01. ***p < .001.
DISCUSSION
In recent decades, invalidating
environments have been highly studied due to their psychological impact on the
individual and are conceptualized as one of the key concepts in various
contemporary therapies (Boggiano & Gagliesi,
2020). Although these elements have been considered in intervention proposals,
psychometric assessment has yet to be developed. ICES is highly regarded among
the main current instruments in this field (Mountford
et al., 2007), translated into Spanish, and adapted to the Peruvian context (Puddington et al., 2017; Okumura-Clark et al., 2023).
Associated with this, current perspectives describe the relevance of using
shorter instruments due to their impact on evaluation and research domains
(Sleep et al., 2021). Under these premises, this research aimed to determine
the psychometric functioning of various ICES versions in Peruvian samples.
Main
findings
Firstly, we sought to determine
the internal structure of the test through the confirmatory factor analysis
method. Various proposals were tested to identify the best-fit indices. The
first proposal consisted of a unidimensional approach; however, the fit indices
could have been better, which would be supported by the theoretical foundations
of the initial ICES version (Mountford et al., 2007).
Secondly, TLI and RMSEA were poorly fit on the Mother Scale based on Puddington et al.’s proposal (2022). Thirdly, it was sought
to replicate the Peruvian version of the ICES (Okumura-Clark et al., 2023), which resulted
in better-fit indices. Subsequently, different versions were tested,
considering correlations between errors (items 1 and 11) in the Mother version
and the elimination of an item in the Father version. Although better-fit
indices were identified, we sought to test a model that did not consider
correlations between item errors and equity in the number of items in both
versions. The 9-item proposal presented the best-fit indices compared to the
previous ones mentioned above. This last version was chosen due to the principles
of parsimony and the fact that it allows the assessment of both factors
(validating and invalidating environments) in a representative and satisfactory
manner (AERA et al., 2014).
Validity evidence based on the
relationship with other variables was obtained. To this end, we sought to
identify the association of the ICES dimensions with anxiety and depression
indicators. Evidence of convergent and divergent validity was obtained through
statistically significant correlations. A key identified component was the
similarity in the effect size about the association’s degree of anxiety and
depression scores with both ICES’ long and short versions. Through these
results, greater support is provided for the plausibility of the interpretation
of the test results in its reduced version (Kline, 2020).
On the other hand, reliability
evidence was determined in the derived scores from the tests. Although
Cronbach's alpha coefficient is the most used to assess reliability, it has
been identified that for its correct estimation, it requires compliance with a
series of assumptions that are difficult to obtain in the psychological field,
such as tau-equivalence, unidimensionality and that
the variables (items) must be continuous and with a normal distribution
(McNeish, 2018). Due to this, the omega coefficient was chosen, which does not
require compliance with such rigid assumptions, in addition to working with
ordinal variables (McNeish, 2018). In that sense, the omega internal
consistency coefficients were similar in both the long and short versions. Due
to these results, the scores derived from the short version are just as precise
and consistent as those from the extended version.
Comparison
with other studies
Psychometric comparisons were
performed between various versions of the ICES. Among the main findings, it was
determined in the first instance that the unidimensional model in both scales
and Puddington et al.’s proposal (2017) on the mother
scale did not meet the minimum expected threshold at the level of adjustment
indices. Another critical point was that better-fit indices were identified in
proposals that used correlations between errors and item elimination; however,
these processes would not be the most recommended in the sense that maintaining
the original factorial structure of the test is preferred. Finally, Okumura-Clark et al.’s proposal
(2023) and the 9-item version demonstrated excellent fit indices; however,
several authors emphasize the relevance of the principles of parsimony in short
versions of the test (Sleep et al., 2021), which is the reason the short
version is recommended for assessment and research aims.
Strength and limitations
Despite its strengths, the present
research has several limitations worth mentioning. The non-probabilistic
sampling method limits the generalizability of the results to other Peruvian
contexts. Additionally, we did not obtain psychometric properties associated
with equity, considered necessary in this field of study. We could not examine
measurement invariance regarding gender or age in our data, as doing so would
have resulted in some groups being too small (fewer than 100 participants),
thus potentially leading to biased or unstable results (Dimitrov, 2010).
Finally, other associated factors, such as different types of invalidation and
elements of therapeutic models of psychotherapy, were not considered.
Implications
in research
This study is a relevant precedent
at a research level, in the sense that this is the first reduced ICES proposal,
having obtained a series of psychometric evidence of validity and reliability
according to current standards for the adaptation and construction of
psychological tests (AERA et al., 2014; ITC, 2017). Research proposals may be
made about this field of study. Among them, we highlight and identify other
psychometric properties of this new version, such as the test's incremental
validity and equity studies.
Conclusion
This study has allowed the
identification of a brief version of 9 items, which presents the same
two-dimensional factor structure and better-fit indices compared to other
previously developed versions. Contrastingly, evidence of convergent and
divergent validity and acceptable internal consistency coefficients were
identified.
ORCID
Alvaro Okumura-Clark: https://orcid.org/0000-0002-4132-8446
Jesus Blancas-Guillen: https://orcid.org/0000-0002-9106-8072
Leandra Ccoyllo-Gonzalez: https://orcid.org/0000-0003-2366-5171
Pablo D. Valencia: https://orcid.org/0000-0002-6809-1805
AUTHORS’
CONTRIBUTION
Alvaro Okumura-Clark: Conceptualization,
introduction, discussion, editing and translation, and approval of the final
version.
Jesus Blancas-Guillen: Methodology, data
recollection, and approval of the final version.
Leandra Ccoyllo-Gonzalez: Methodology,
data recollection, and approval of the final version
Pablo D. Valencia: Conceptualization, data
analysis, results, editing and translation, and approval of the final version
FUNDING SOURCE
This study has not been funded by any institution.
CONFLICT OF INTEREST
The authors declare no conflicts of interest in
collecting data, analyzing information, or writing the manuscript.
ACKNOWLEDGMENTS
Not applicable.
REVIEW PROCESS
This study has been reviewed by external peers in double-blind mode.
The editor in charge was David
Villarreal-Zegarra. The review process is included as supplementary
material 1.
DATA AVAILABILITY STATEMENT
The authors attach the database as supplementary material 2.
DISCLAIMER
The authors are responsible for all statements made in
this article.
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