You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Functional Neuroanatomy of Body Shape Perception in Healthy and Eating-Disordered Women
Abstract 1:
BACKGROUND Abnormalities in perception and evaluation of body shape are a hallmark of eating disorders . METHODS Brain responses to line drawings of underweight , normal weight , and overweight female bodies were measured with functional magnetic resonance imaging in 9 women with bulimia nervosa , 13 with anorexia nervosa , and 18 healthy women . Participants rated the stimuli for fear and disgust . RESULTS In the three groups , the lateral fusiform gyrus , inferior parietal cortex , and lateral prefrontal cortex were activated in response to body shapes compared with the control condition ( drawings of houses ) . The responses in the lateral fusiform gyrus and in the parietal cortex were less strong in patients with eating disorders compared with healthy control subjects . Patients with eating disorders rated the body shapes in all weight categories as more aversive than did healthy women . In the group with eating disorders , the aversion ratings correlated positively with activity in the right medial apical prefrontal cortex . CONCLUSIONS Processing of female body shapes engages a distributed neural network , parts of which are underactive in women with eating disorders . The considerable variability in subjective emotional reaction to body shapes in patients with eating disorders is associated with differential activity in the prefrontal cortex


Title 2:
The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
Abstract 2:
OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity


Title 3:
Comparison of regional cerebral blood flow in patients with eating disorders
Abstract 3:
We used single photon emission computed tomography ( SPECT ) with Tc-99m-HMPAO to examine the characteristics of regional cerebral blood flow ( rCBF ) in five patients with bulimia nervosa ( BN ) , eight patients with anorexia nervosa ( AN ) , and in nine healthy controls . The SPECT examinations were performed before and after food intake stimulus , and the values of the corrected ratio ( R ) for rCBF in 10 cerebral cortical regions before ( Rbefore ) and after eating ( Rafter ) were calculated . The asymmetry indices ( AI ) of the R values for the left and right side of each cortical region and the percent change from Rbefore to Rafter ( % change ) were computed . In comparison with the other two groups , BN patients showed significantly higher Rbefore values in the bilateral inferior frontal and left temporal regions . The AN patients showed significantly lower Rbefore values in the left parietal region than the control group . There were no significant differences in Rafter values among the three groups . The % change values in the AN group showed the greatest increase in 9 out of the 10 regions . In contrast to the positive values obtained from the 10 regions observed in the AN group , 5 out of the 10 regions in the BN group showed negative values . Among the three groups , significant differences in % change were observed on both sides of the inferior frontal , temporal , parietal , and occipital regions . These findings indicate that differences in cerebral function of BN and AN patients can be characterized through SPECT imaging


Title 4:
Reward-Based Spatial Learning in Teens With Bulimia Nervosa.
Abstract 4:
OBJECTIVE To assess the functioning of mesolimbic and fronto-striatal areas involved in reward-based spatial learning in teenaged girls with bulimia nervosa ( BN ) that might be involved in the development and maintenance of maladaptive behaviors characteristic of the disorder . METHOD We compared functional magnetic resonance imaging blood oxygen level-dependent response in 27 adolescent girls with BN to that of 27 healthy , age-matched control participants during a reward-based learning task that required learning to use extra-maze cues to navigate a virtual 8-arm radial maze to find hidden rewards . We compared groups in their patterns of brain activation associated with reward-based spatial learning versus a control condition in which rewards were unexpected because they were allotted pseudo-r and omly to experimentally prevent learning . RESULTS Both groups learned to navigate the maze to find hidden rewards , but group differences in brain activity associated with maze navigation and reward processing were detected in the fronto-striatal regions and right anterior hippocampus . Unlike healthy adolescents , those with BN did not engage the right inferior frontal gyrus during maze navigation , activated the right anterior hippocampus during the receipt of unexpected rewards ( control condition ) , and deactivated the left superior frontal gyrus and right anterior hippocampus during expected reward receipt ( learning condition ) . These patterns of hippocampal activation in the control condition were significantly associated with the frequency of binge-eating episodes . CONCLUSION Adolescents with BN displayed abnormal functioning of the anterior hippocampus and fronto-striatal regions during reward-based spatial learning . These findings suggest that an imbalance in control and reward circuits may arise early in the course of BN . Clinical trial registration information-An fMRI Study of Self-Regulation in Adolescents With Bulimia Nervosa ; https:// clinical trials.gov/ ; NCT00345943


Title 5:
Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up
Abstract 5:
The present study is a r and omized controlled trial that aims to evaluate the efficacy of Neurofeedback compared to st and ard pharmacological intervention in the treatment of attention deficit/hyperactivity disorder ( ADHD ) . The final sample consisted of 23 children with ADHD ( 11 boys and 12 girls , 7 - 14 years old ) . Participants carried out 40 theta/beta training sessions or received methylpheni date .  Behavioral rating scales were completed by fathers , mothers , and teachers at pre- , post-treatment , two- , and six-month naturalistic follow-up . In both groups , similar significant reductions were reported in ADHD functional impairment by parents ; and in primary ADHD symptoms by parents and teachers . However , significant academic performance improvements were only detected in the Neurofeedback group . Our findings provide new evidence for the efficacy of Neurofeedback , and contribute to enlarge the range of non-pharmacological ADHD intervention choices . To our knowledge , this is the first r and omized controlled trial with a six-month follow-up that compares Neurofeedback and stimulant medication in ADHD


Title 6:
Repetitive Transcranial Magnetic Stimulation Reduces Cue-Induced Food Craving in Bulimic Disorders
Abstract 6:
BACKGROUND Craving or the " urge to consume " is a characteristic of bulimic eating disorders and addictions . Dysfunction of the dorsolateral prefrontal cortex ( DLPFC ) is associated with craving . We investigated whether stimulation of the DLPFC reduces food craving in people with a bulimic-type eating disorder . METHODS Thirty-eight people with bulimic-type eating disorders were r and omly allocated to receive one session of real or sham high-frequency repetitive transcranial magnetic stimulation ( rTMS ) to the left DLPFC in a double-blind procedure . Outcome measures included self-reported food craving immediately after the stimulation session and frequency of bingeing over a 24-hour follow-up period . RESULTS Compared with sham control , real rTMS was associated with decreased self-reported urge to eat and fewer binge-eating episodes over the 24 hours following stimulation . CONCLUSIONS High-frequency rTMS of the left DLPFC lowers cue-induced food cravings in people with a bulimic eating disorder and may reduce binge eating . These results provide a rationale for exploring rTMS as a treatment for bulimic eating disorders
A small number of consistent findings emerged in individuals in the acute phase of illness with BN or BED including : volume reduction and increases across a range of areas ; hypoactivity in the frontostriatal circuits ; and aberrant responses in the insula , amygdala , middle frontal gyrus and occipital cortex to a range of different stimuli or tasks ; a link between illness severity in BN and neural changes ; diminished attentional capacity and early learning ; and in SPECT studies , increased rCBF in relation to disorder-related stimuli .
One clear finding is that illness severity , exclusively defined as the frequency of binge eating or bulimic episodes , is related to greater neural changes .