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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 2  |  Page : 129-137

Attitude, practice orientation, benefits and barriers towards health research and publications among medical practitioners in Abia State, Nigeria: A cross-sectional study


1 Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
2 Department of Public Health, Federal University of Technology Owerri, Nigeria
3 Department of Environmental Health Sciences, Faculty of Basic Medical Sciences, College of Medicine and Health Sciences, Abia State University, Uturu, Abia State, Nigeria
4 Department of Family Medicine, Federal Teaching Hospital Ido Ekiti, Nigeria
5 Department of Psychiatry, Federal Medical Centre, Umuahia, Nigeria

Date of Submission07-Jul-2018
Date of Acceptance07-Sep-2019
Date of Web Publication7-Feb-2020

Correspondence Address:
Dr. G U Pascal Iloh
Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_284_18

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   Abstract 


Background: Health research is an essential component of medical training, education, and practice and is fundamental in establishing the scientific basis of health care. Aim: The study was aimed at describing the attitude, practice, benefits, and barriers towards health research and publications in a cross-section of medical practitioners in Abia State, Nigeria. Materials and Methods: This was a cross-sectional descriptive study carried out on 210 medical practitioners in Abia State. Data collection was done using pretested, self-administered questionnaire that elicited information on attitude, practice, benefits, and barriers toward health research. Awareness of research misconduct, types of published research articles, and factors considered in selection of journals for publication of research were also studied. Results: The age of the participants ranged from 26 to 77 years. There were 173 (82.4%) men. The overall attitude toward research was moderate (x = 5.02 ± 0.96). All the respondents (100%) were involved in undergraduate research projects while 72 (34.3%) had at least one journal publication with the most commonly published articles being descriptive studies. The commonest barriers to research were financial and time constraints while the greatest benefits of research were advancement of medical knowledge and keeping practitioners abreast with evidence-based medicine. The commonest research misconduct was plagiarism while the most common factor considered in selection of journals for publication was article publication charges. Middle age group and years of practice more than 10 years were significantly associated with publication of journal articles (P < 0.05). Conclusion: This study has shown that the study participants had moderate positive attitude toward research with all the participants previously involved in undergraduate research and only one third had at least one journal publications. The commonest barriers were financial and time constraints and greatest benefits of health research was advancement of medical knowledge and keeping practitioners abreast with evidence-based medicine. Choice of journal for publications is preeminently determined by article publication charges. The most common article published and research misconduct was descriptive studies and plagiarism, respectively.

Keywords: Attitude, barriers, benefits, health research, misconduct, Nigeria, practice


How to cite this article:
Pascal Iloh G U, Amadi A N, Iro O K, Agboola S M, Aguocha G U, Chukwuonye M E. Attitude, practice orientation, benefits and barriers towards health research and publications among medical practitioners in Abia State, Nigeria: A cross-sectional study. Niger J Clin Pract 2020;23:129-37

How to cite this URL:
Pascal Iloh G U, Amadi A N, Iro O K, Agboola S M, Aguocha G U, Chukwuonye M E. Attitude, practice orientation, benefits and barriers towards health research and publications among medical practitioners in Abia State, Nigeria: A cross-sectional study. Niger J Clin Pract [serial online] 2020 [cited 2020 Jul 5];23:129-37. Available from: http://www.njcponline.com/text.asp?2020/23/2/129/277858




   Introduction Top


Globally, health research is crucial in the advancement and improvement of quality of care provided in healthcare environment.[1],[2],[3] The clinical relevance and significance of health research have therefore continued to generate interest among medical practitioners worldwide as it contributes to continuing professional development and health system strengthening.[3],[4],[5],[6] In 1990, Commission on Health Research and Development highlighted the need for Essential National Health Research[7] and in 2013, World Health Report demonstrated the essential role of health research in population health in both resource-rich and poor countries and its impact on health system strengthening, performance, development goals, and universal health coverage.[8],[9] As a concept, research is defined as the systematic collection, analysis, and interpretation of data to answer a certain question or solve a problem.[10] Health research therefore refers to health-related research activities and encompasses wide array of research such as basic (bench), clinical (bedside), community-based, applied and translational research. Health science research is often categorized in a variety of ways that connote the purpose, scope, nature of data and interventions, methodological orientation or research design and has been described to exist in different forms like descriptive, analytical, and interventional research studies.[11]

The development of research capacity has been demonstrated to be quintessential at individual (personal) as well as institutional level in order to attain a sustainable improvement in health research output.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21] The attitude and practice of health research has been reported among different categories of medical professionals in different parts of the world such as United States of America,[12] Canada,[13] Japan,[14] Australia,[15] Pakistan,[16] India,[17] Saudi Arabia,[18] Oman,[19] and Nigeria.[20],[21] The attitudes and experiences in the conduct of research studies have also been reported across clinical disciplines and specialties in medical practice like family physicians,[22] primary care practitioners,[23] gastroenterologists,[24] medical doctors in postgraduate residency training,[21],[22],[25] and postgraduate university academic medicine.[16],[17] Biomedical literature is also replete with numerous benefits of health research especially in advancing the knowledge and competence of medical practitioners,[1],[26] keeping practitioners in touch with evidence-based medicine and practice guidelines for standard patient care,[1],[27] enhances intraprofessional communication,[28] enhances career progression and promotion in academic medicine,[29] improving research situation in the country,[30] health policy orientation,[31] and development of physician--scientists.[32]

Factors that constitute barriers to the successful engagement and conduct of health science research have been reported in biomedical literatures[33],[34],[35],[36],[37] and these include lack of time, intense workload, poverty of financial and infrastructural support, inadequate research guidance, supervision and mentoring, lack of interest, motivation and reward, inadequate training on research methods, and diminished awareness about the importance of health science research. However, research studies have indicated that medical professionals in developing nations face more obstacles in conducting and publishing research studies compared to their counterparts in developed nations including deficient motivational environment and information, communication and technology support for research work.[4],[5],[6],[36],[37],[38],[39]

Several methods of measuring attitude to research have been described and there are author-system wide discrepancies in consensual tools for determining attitude toward research. There exists attitude toward research scale such as 32-items attitude toward research scale by Papanastasiou[40] scored in 7 point Likert scale responses and assesses usefulness of research, research anxiety, attitude toward research, relevance of research to life and research difficulty; 13-items reversed attitude toward research scale by Papanastasiou[41] scored in 7 point Likert scale responses which evaluate usefulness of research, research anxiety, and attitude toward research; 60-items attitude toward research scale by Aqil et al.[42] scored in 5 point Likert scale which measures usefulness of research, relevance of research in personal and social life, ethics of research, difficulty of research and anxiety, and general aspects of research and research process and 8-items attitude toward research by Abushouk et al.[43] scored on 3-point Likert scale and 14-item attitude toward research scored on 5-point Likert scale by Noorelahi et al.,[44] and attitude toward research by Vodopivec et al.[45] However, there is no gold standard attitude toward research scale or questionnaire tool for precise assessment of attitude toward research in healthcare settings or specific to a particular subject discipline in health science.

In recent years, there has been an explosive increase in number of journal publishers and publications worldwide.[46],[47],[48] In Nigeria, the quality of health science research is an issue of concern in the sub-region.[20],[21] However, there are several widely held ideas and misconceptions about health research in the sub-region with anecdotal observations throwing more light on the various perils and pearls of authors of academic publications.[20],[21] Adequate level of knowledge, skills, ability, and positive attitude play important role in carrying out health research. Identifying the research attitude and practice among medical practitioners in Nigeria is critical in determining the quantity and quality of health research and will provide the opportunity to stimulate interest in research endeavors among practitioners of medical science. The creation of appropriate attitude and overcoming the factors that constitute obstacles to health research preeminently relies on medical professionals' attitudinal orientation to the principles and practice of scientific and academic research conduct. It is based on this background that the authors were motivated to study the attitude, practice orientation, benefits, and barriers to health research in a cross-section of medical practitioners in Abia State, Nigeria.


   Subjects and Methods Top


A cross-sectional descriptive study was carried out on 210 public and private medical professionals who participated in continuing professional development program organized by Directorate of Postgraduate Studies of Federal Medical Centre Umuahia, Nigeria, for medical professionals in Abia State, on 3rd and 4th May 2017 or opening ceremony for 2017 Physicians week of Nigerian Medical Association, Abia State, held on 23rd October 2017. The questionnaire tool was administered to each eligible medical practitioner once either during the opening ceremony of 2017 Physicians week organized by Nigerian Medical Association, Abia State chapter or continuing professional development program organized by Directorate of Postgraduate Studies of Federal Medical Centre Umuahia, respectively.

The sample size for the study was estimated using online sample size calculating software. The input criteria for sample size determination was set at 95% confidence level, confidence interval of 5, and accessible population of 300 medical practitioners based on the previous summative Federal Medical Centre, Umuahia, continuing professional development and Abia State Physicians week attendance registers. This gave a sample size estimate of 169 subjects. However, sample size of 210 medical doctors was used in order to improve the precision of the study. The online sample size calculator is available at www.surveysystem.com, accessed on 1st February 2017.

The eligible medical practitioners were consecutively recruited for the study based on the inclusion criteria until the sample size of 210 was achieved. The inclusion criteria were private and public medical practitioners in Abia State who participated in continuing professional development program organized by Directorate of Postgraduate Studies of Federal Medical Centre Umuahia, Nigeria for medical professionals in Abia State or opening ceremony of 2017 Physicians week by Nigerian Medical Association, Abia State, respectively. Participation in the study was completely voluntary and full confidentiality and anonymity was maintained at all time with no identifiable respondents biometrics recorded in the study tool.

The study tool consisted of sections on sociodemographic data such as age, sex, years of practice, and information on attitude toward research, practice orientation, benefits and barriers to research, factors considered in selection of journals for publication of articles, types of published research articles, and awareness of research/publication misconduct.

The attitude toward research instrument was adapted from prevalidated 13-item questionnaire tool scored on a 7-point Likert scale designed by Papanastasiou[41] and modified to suit the study participants who were practicing medical professionals. The 4-item subscale of the attitude toward research tool was used as follows: I enjoy involvement in research; I love research activities and publication; I find research activities and publications interesting and research activities and publications are pleasant. The minimum and maximum possible scores on each item of the attitude subscale were 1 and 7. The mean score from all the attitude items was calculated from the individual scores. Higher scores indicate positive attitude toward research while lower scores reflect less encouraging attitude toward research. Operationally, low, moderated, and high levels of attitude toward research were scores of 1.00 – 3.50; 3.51 – 5.49 and ≥ 5.50, respectively.

The practice, benefits, and barriers sections of the questionnaire were designed by the researchers to suit Nigerian environment through robust review of appropriate literature on health research.[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[40],[41],[42],[43],[44],[45] Research practices included questions regarding conduct of undergraduate research project, participation in research publications in journals, actual publication of research papers in journals, and actual presentation of research papers or posters in scientific conferences. The responses were recorded in a dichotomous “yes” or “no” format. Face validity of the practice, benefits, and barriers sections of the questionnaire were obtained through a review process with experts in the field of health research.

The questionnaire tool was pretested using 10 medical doctors at Federal Medical Centre, Umuahia. The pretesting was done to find out how the questions would interact with the respondents and ensure there were no ambiguities. However, no change was necessary after the pretesting as the questions were interpreted with the same meaning as intended. The questionnaire was self-administered since the participants are health literate.

Operationally, attitude toward research referred to the extent to which the medical practitioner like, take interest, and feel pleasant about research while practice of health research meant the habits of medical practitioner regarding involvement or participation in research like undergraduate projects, diploma or master's theses, postgraduate fellowship or doctoral dissertations, journal publications, scientific and conference oral, or poster presentations and communications.

The data generated were analyzed using software International Business Machines Corporation, Statistical Package for Social Sciences (IBM SPSS) version 21, New York, USA. Categorical variables were described by frequencies. Bivariate analysis involving Chi-square test was used to test for significance of association between categorical variables. In all cases, a P value of <0.05 was considered statistically significant and was estimated at 95% confidence limit.


   Results Top


Two hundred and ten medical practitioners participated in the study of whom 111 (52.8%) were middle-aged adults (40–59 years), 76 (36.2%) were young adults (18–39 years), and 23 (11.0%) were aged 60--77 years. The age of the participants ranged from 26 to 77 years with mean age of 36 ± 8.4 years. There were 173 men (82.4%) with 37 women (17.6%) with female--male ratio of 1:4.7. Other demographic characteristics of the study participants are shown in [Table 1].
Table 1: Demographic variables of the study participants

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[Table 2] shows the distribution of the study subjects by attitude toward research and practice orientations. The mean attitude toward research ranged from 4.10 to 6.22 with overall mean attitude of 5.02 ± 0.96. Two hundred and ten (100%) participants had been involved in undergraduate research projects, ninety-seven (46.2%) participated in the conduct of research for journal publications while 72 (34.3%) had at least one journal publication.
Table 2: Distribution of the study subjects by attitude towards research and practice orientation (n =210)

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[Table 3] shows the distribution of the study respondents who had publications by the type of research articles published, of the 72 participants who had publications in scientific journal, 100% of them had published descriptive research studies while five (6.9%) had published interventional research articles. The most common factor considered in selection of journals for publication of research articles was article publication charges.
Table 3: Distribution of study participants who have publications by the type of research articles and factors considered in selection of journals for publications (n=72)

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Of the 210 medical practitioners who participated in the study, the greatest benefits of research were advancement of medical knowledge (100%) and keeping practitioners abreast with evidence-based medicine (100%) while the commonest barriers to research were financial (100%)) and time constraints (100%). [Table 4]
Table 4: Benefits and barriers to health research among the study subjects (n=210)

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Of the 72 medical professionals who had publications in scientific journals, the involvements in research process were preeminently skewed toward distribution and collection of research questionnaires. The most common research misconduct the respondents were aware was plagiarism (100.0%) while 11 (15.3%) of the participants were aware of predator journals. [Table 5]
Table 5: Aspects of involvement in research process and awareness of research misconduct among participants who have publications (n=72)

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On bivariate Chi-square analysis of the association of demographic variables as related to publication of research articles in scientific journals, middle age group (40--59) (X2 = 23.65; P < 0.05) and years of practice more than 10 years (X2 = 15.27; P < 0.05) were significantly associated with publication of research articles [Table 6].
Table 6: Association between demographic profile and publication of research articles

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   Discussion Top


This study has shown that the study participants had moderate positive attitude toward research. This is in consonance with reports from Owo, Nigeria[20] and other parts of the world like India,[17] Saudi Arabia,[18] and Oman.[19] According to these reports, positive attitude toward health research is essential in advancing medical science and extending the frontiers of medical training, education, development, and evidence-based medical practice. Of great interest is that medical practitioners live and work in a society made up of people from different social classes and who have easy access to medical information from internet. Medical professionals are often seen by the wider society as authorities in several issues relating to health, thereby creating the feeling of an expert interactions during patient--doctor communication. It is therefore vital that medical practitioners in the region realize this and make sustained efforts to brace up with current issues on health science research for improved and sustainable development of medical knowledge. There is need to encourage practice-based health science research in the region as a component of continuing medical education and continuing professional development. This will help to improve the quality and quantity of health research among medical practitioners as well as impact on the necessary research competence required of a 21st century medical professionals in order to reinforce the growing link between health research, policies, and action.[1],[2],[7] Developing positive attitude toward health research is the need of the century and crucial in carrying out research activities and publication of research articles.

This study has shown that all the respondents had been involved in undergraduate research projects (100.0%) while 72 (34.3%) had at least one journal publication. The 100% participation in undergraduate research projects among the study participants is a reflection of the mandatory prerequisite academic condition of conduct and submission of research project as a requirement for the award of Bachelor of Medicine, Bachelor of Surgery degrees by National Universities Commission of Nigeria. Although health science research conceptualization and contextualization are complex academic and professional activities, there is need for practitioners of the noble science and art of medicine to be involved in health research regardless of age, gender, place of work, professional status, and area of specializations. Despite the fact that medical practitioners in the region are involved in busy medical practice, they most times encounter patients with attributes that are appropriate for research purposes but the time required for health research is largely whittled away by patient care and other demanding personal, social, and domestic demands. Medical practitioners in Nigeria can have good clinical practice as well as good clinical research practice. Health science research therefore offers to the medical practitioner critical thinking and heuristic reasoning, improved patient care based on the best available evidence, lifelong learning, and medical education.[1],[30]

Seventy-two (34.3%) of the study participants had published at least one research article in scientific journals with predominant article being descriptive studies and most common factor considered in selection of journals for manuscript submission was article publication charges. Although the relevance of health science research is well recognized in medical practice, only one third of the study participants had published articles in scientific journals. This finding could be a reflection of the reports that in resource-poor countries that health research is not a high priority for medical practitioners.[4],[5],[6] This could be due to poverty of research financial resources amidst other factors. Admittedly, the undergraduate projects, masters theses, doctoral, or fellowship dissertations undertaken by medical professionals in Nigeria during undergraduate and postgraduate medical education are not often done with the intention of introducing the medical graduate to research methods to equip him or her with competence for research publications but rather undertaken to fulfill curricular requirements for award of degrees, diplomas, and fellowships. The research projects, theses, and dissertations are therefore carried out not because of love for health science research or a need to add anything new on the existing body of knowledge but just to pass the prescribed examinations. This could be part of the reasons for largely producing medical professionals with inadequate research orientation and those whose research output are not of publishable quality. Until a critical mass of research-oriented medical professionals is created to tackle the long-term disparities in research output in the region, this poverty of research publications will likely continue unabated.

The most common benefits of research in this study were advancement of medical knowledge and keeping medical practitioners abreast with evidence-based medicine. This is in agreement with the findings from previous studies.[26],[27],[30],[32] In this era of evidence-based medical practice, health science research is one of the ways of advancing medical science and achieving prosperity in healthcare environments. Health science research studies can result in the design of algorithms and clinical practice guidelines that help clinicians identify clinical characteristics that are associated with optimal patient response to patient-oriented interventions such as medication regimen.[27],[28] Although clinical practice guidelines based on evidence from research may not be applicable to every patient encountered in every practice population but it can be of immense value in promotion and provision of standard care as well as standardization of medical care. Health research is therefore important in ensuring that patients are given quality of care in the most efficient, effective, and beneficial evidence-based manner.

The most common barriers to health research in the study were constraints of financial and time resources. These barriers to health research have been reported particularly in developing countries with limited health resources and chaotic health system environment.[20],[33],[36],[39] This could be a reflection of poverty of political will toward research in addition to economic depression and repression which results in the neglect of the role of research in health policy and healthcare delivery.[29],[30] In Nigeria, there is little or no incentive to pursue career in research and public funding of health research is limited and research activities are predominantly funded from out-of-pocket expenses. Addressing financial barriers and other personal and institutional constraints to health research among medical practitioners in the region is an opportunity we cannot afford to waste since health research helps in improving the way in which services are conducted and rendered to the consumers of healthcare goods and services.

The most important factor considered in submission of manuscripts for publication by respondents who have published articles in biomedical journals was article publication charges. This could be an extrapolation of the barriers to health research where the commonest barrier to health research in the region was financial constraints. Although various factors have been documented in the choice of journal for publication of research articles such as impact factors and other publication indices,[29],[46],[47],[48] the finding of this study could be a mirror of resource-poor climate of health science research in the region. Resources invested in health research are considered worthwhile and yield academic dividends when such research work is published in journals with high impact factors. There is therefore the need for availability of fund for health research and institutional support in the payment of article publication charges for prestigious journals with high impact factors. Improvement in health research structural resources in the region is definitely desirable and the time to start is now.

The commonest research misconduct the respondents were aware of was plagiarism. This finding is in accordance with reports from biomedical journals from Nigeria[49] and other parts of the world.[50],[51] According to these reports,[49],[50],[51] plagiarism is a crime on academic and professional integrity that impacts adversely on the credibility, reliability, and validity of scholarships at all levels of medical education and professionalism. Although most institutions and journals have policies for dealing with plagiarism or breaches of research ethics, unfortunately transparency has often been founding lacking.[50],[51] To address the issue of plagiarism, various institutions and journals have policy to deter breaches of research and publication misconduct.[52],[53] The onus remains on the authors to guard against plagiarism and refrain from such unethical research behavior and practice. Adequate awareness of the plagiarism among the medical professionals will help to minimize breaches of the ethical principles of biomedical research and the attendant ethical fallacies related to unjustified biomedical research. The finding of this study also underscores the need for active interventions by all stakeholders in health science research to implement measures to overcome the misconduct associated with research activities in the region.

Eleven (15.3%) of the study subjects have heard of predator publishers and journals. This terminology emerged due to explosion in open access publications with intention to shoddy and inferior publication practices such as questionable journal metrics, false logos of affiliated abstract and indexing data bases, absence or poverty of peer review process and list of editorial board members with doubtful or padded qualifications.[48],[54],[55] According to Jeffrey Bealls,[56] who is the watchdog for potential, possible, or probable predator publishers who emphasized that these predatory journals are primarily fee-collecting organizations that publish articles without peer review despite claim to the contrary, poor copy editing and proof reading, purported addresses, and partial or completely plagiarized articles. Admittedly, low quality or problematic publication is not only unique to predator journals but also to some respected and reputedly indexed journals.[56] This issue is not widely known in Nigeria where there is intense pressure to publish by medical practitioners in academic medicine to earn promotion and advancement (publish or perish syndrome).[29] Medical professionals who engage in research publications should therefore be cautious when shopping online for journals. It is therefore quintessential to recognize predator publishers and avoid them.

Medical practitioners who were aged 40--59 years (middle age) were more likely to have research publications compared to younger and older medical practitioners. This is similar to reports from Owo, Nigeria[20] and other parts of the world like Australia.[15] This finding could be a reflection of active participation in research methodology course and easy navigation through the difficult terrain of health research by middle-aged medical doctors. Every medical practitioner irrespective of chronological or professional age has hippocratic duty of care for his/her patients and should provide effective treatment based on the best available evidence. The duty of care requires up-to-date knowledge of the current management of patients' medical conditions. It is therefore crucial that medical practitioners in Nigeria should contribute to the generation of medical evidence by conducting health research in as much as the outcome of medical research benefits both the young and old practitioners and the patients. Medical practitioners should think of research in everyday clinical practice in order to nurture, foster, and imbibe research culture in healthcare settings in Nigeria.

Limitations of the study

The limitations of this study are recognized by the researchers. The attitude toward research and publication of research articles were based on respondents' subjective responses and were not verified. The limitations of Likert scale responses of attitude toward research scale are also recognized. However, the score distribution of items on attitude toward research scale was checked to ensure that there were no central or ceiling effects.


   Conclusion Top


This study has shown that the study participants had moderate positive attitude toward research with all the participants previously involved in undergraduate research projects and only one third had journal publications. The commonest barriers were financial and time constraints and greatest benefits of health research were advancement of medical knowledge and keeping medical practitioners abreast with evidence-based medicine. Choice of journal for publications is preeminently determined by article publication charges. The most common article published and research misconduct was descriptive studies and plagiarism, respectively.

Recommendations

The principles and practice of health research should be the target of intensive continuing professional development and medical education in addition to greater institutional support for research especially in resource-constrained settings where there are limited options for high hierarchy and impact research activities. This will help the medical practitioners to develop positive attitude and adequate involvement in health research and empower them with competence and capacity to effectively conduct health science research.

Recommendation for further studies

Future research directions are required to compare the attitude, practice orientation, benefits, and barriers toward health research and publications among medical practitioners in different geo-ecological and political regions of Nigeria. This will provide additional epidemiological data for comparative and consultative purposes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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