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Evidences on overweight of regular blood donors in a center of Southern Italy

  • Author Footnotes
    1 Authors contributed equally to this work.
    Maria Vasco
    Correspondence
    Corresponding author.
    Footnotes
    1 Authors contributed equally to this work.
    Affiliations
    U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Department of Internal Medicine and Specialistics, University of Campania “Luigi Vanvitelli”, Naples, Italy
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  • Author Footnotes
    1 Authors contributed equally to this work.
    Dario Costa
    Footnotes
    1 Authors contributed equally to this work.
    Affiliations
    U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Department of Internal Medicine and Specialistics, University of Campania “Luigi Vanvitelli”, Naples, Italy
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  • Michele Scognamiglio
    Affiliations
    U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Department of Internal Medicine and Specialistics, University of Campania “Luigi Vanvitelli”, Naples, Italy
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  • Giuseppe Signoriello
    Affiliations
    Department of Mental Health and Preventive Medicine, Chair of Statistics, University of Campania “Luigi Vanvitelli”, Naples, Italy
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  • Roberto Alfano
    Affiliations
    Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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  • Karin Magnussen
    Affiliations
    Department of Blood Centre and Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway
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  • Claudio Napoli
    Affiliations
    U.O.C. Division of Clinical Immunology, Immunohematology, Transfusion Medicine and Transplant Immunology, Department of Internal Medicine and Specialistics, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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  • Author Footnotes
    1 Authors contributed equally to this work.
Published:January 28, 2020DOI:https://doi.org/10.1016/j.cegh.2020.01.015

      Abstract

      Objective

      Smoking, unhealthy diet and obesity, sedentary behavior and inability to maintain adequate exercise have significant consequences for several chronic disorders. Blood centers can play a public health role in obesity surveillance and interventions. The purpose study was to evaluate the health status of the blood donors by monitoring the nutritional habits and lifestyle.

      Methods

      A descriptive cross-sectional face-to-face questionnaire was developed. It included a 41 item dietary assessment, reporting semi-quantitative food frequency, dietary behavior and questions on self-rated health status. Donors were regular repeat blood donors, eligible to donate.

      Results

      Of the 2468 blood donors enrolled between July 2017 and January 2018, 1390 were repeat donors. Only 205 agreed to respond to the questionnaire. Data showed that donors followed mainly a Mediterranean diet and had more awareness to lifestyle, women more than men, in comparison with general population. The prevalence of overweight was found 50.7% in men and 16.9% in women.

      Conclusions

      Overweight and obesity are common among regular blood donors and it is more frequent in men than women. The female blood donors seem to be characterized by better knowledge on the relationship between lifestyle and health, and by a better “putting into practice” of the information possessed.

      Keywords

      1. Introduction

      The quality of life, self-reported by the patient, related to health and adequate quali-quantitative nutrition, are becoming necessary and relevant in the field of nutrition.
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      A systematic review and narrative synthesis of interventions for uncomplicated obesity: weight loss, well-being and impact on eating disorders.
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      Food insecurity is associated with subjective well-being among individuals from 138 countries in the 2014 gallup world poll.
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      Satisfaction with life and food-related life in Ecuadorian older adults.
      A regular monitoring of dietary aspects and lifestyle, with the aim of correcting the inexpedient behavior could provide an essential improvement in the health.
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      Development and evaluation of a short instrument to estimate usual dietary intake of percentage energy from fat.
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      Development and evaluation of a brief screener to estimate fast-food and beverage consumption among adolescents.
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      Dietary assessment methods in epidemiologic studies.
      Smoking, unhealthy diet and obesity, sedentary behavior and inability to maintain adequate exercise represent the most important risk factor associated to several chronic disorders, including cardiovascular diseases, diabetes, dyslipidemia and cancer.
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      Associations between food and beverage groups and major diet-related chronic diseases: an exhaustive review of pooled/meta-analyses and systematic reviews.
      The situation is worrying considering data from World Health Organization (http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight) with more than 1.9 billion adults (18 years and older) overweight and over 650 million obese, showing an increase of obesity rate of three fold since 1975. To adequately describe the magnitude of the phenomenon it was necessary to introduce the term of globesity, indicating a considerable health problem and of health public due to the “global and growing epidemic of overweight and obesity” which threatens the world population health.
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      Globesity: the root causes of the obesity epidemic in the USA and now worldwide.
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      Nutritional status and socio-ecological factors associated with overweight/obesity at a rural-serving US-Mexico border university.
      In Italy, data demonstrated that overweight and obesity is increasing with 3 adults of 10 overweight and 1 of 10 obese in 2017. In particular, data showed a gradient from North to South of Italy with a higher frequency of overweight and obesity in the South.
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      A national survey of the prevalence of childhood overweight and obesity in Italy.
      Health should not be considered only as the absence of disease but must ensure full physical, mental, social and occupational satisfaction.
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      The role of diet and nutrition on mental health and wellbeing.
      ,
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      Physical activity and health perception in aging: do body mass and satisfaction matter? A three-path mediated link.
      However, only few studies on the psychological well-being related to nutritional studies have been reported.
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      • Hunter J.
      • Delgadillo-Chase D.
      If, why, and when subjective well-being influences health, and future needed research.
      Blood Center data could provide an excellent opportunity for dissecting the lifestyle assessment of blood donors. So, in this study we administered a questionnaire to blood donors in order to investigate their physical activity, dietary intake, smoking, alcohol consumption and health-related life satisfaction. The purpose of this study was to evaluate the health status of the blood donors by monitoring the nutritional status and lifestyle.

      2. Patients and methods

      2.1 Participants

      The survey was conducted at the UOC of Clinical Immunology, Immunohematology and Transfusion Medicine of the University of Campania “L. Vanvitelli”, which usually investigates blood donors.
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      Comparison of performance of two Treponema pallidum automated chemiluminescent immunoassays in blood donors.
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      Clinical outcome of transfusions with extended red blood cell matching in β-thalassemia patients: a single-center experience.
      We comprised data of all successful blood donations from July 2017 to January 2018. We selected only blood donors who had made at least 3 donations in the last 2 years (repeat donors). During the study period, for donors who gave more than one donation, data were recorded only at their first donation.
      Donors that didn't meet the eligibility criteria for blood donation, according to national guidelines, were not included in the study [http://www.centronazionalesangue.it/sites/default/files/it_standards_transf_med.pdf]. Whole blood donations, as well as red blood cell and platelet apheresis were included. Height and weight were measured and recorded at the time of donation by blood centre personnel. From every donor written consent was obtained to provide blood samples for research purposes. Ethics approval was provided by the University of “Luigi Vanvitelli” Human Research Ethics Committee (n. 538618).

      2.2 Questionnaire

      As reported by Rigas et al.,
      • Rigas A.S.
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      • et al.
      Predictors of iron levels in 14,737 Danish blood donors: results from the Danish Blood Donor Study.
      we developed a descriptive cross-sectional face-to-face questionnaire with 41 questions for lifestyle assessment. There were questions on blood donors' demographics covering the age, gender, education, social class and occupation. The second part included the questions on the blood donors’ nutritional habits and lifestyle, including 13 semi-quantitative food frequency questions and 19 dietary behavior questions. They were also asked about their physical activity, smoking, and alcohol consumption. Also the frequency and intensity of physical activity were assessed. Self-rated health status was also reported (participants were asked “In general, would you say that your health is excellent, very good, good, fair, or poor?”); the number of days in the last month in which the respondent did not feel well for physical reasons, the number of days when he/she was not feeling well for mental and/or psychological reasons and the number of days in which he/she had limitations in habitual activities.

      2.3 Statistical analysis

      Body mass index (BMI) was calculated as weight (in kilograms) divided by the square of height (in meters). Normal weight was established with BMI<25 kg/m2, overweight with a BMI≥25 and < 30 kg/m2, and obesity with BMI≥30 kg/m2. Obesity prevalence was standardized by sex. Finally, adjusted odds ratios (aOR) for obesity and 95% confidence intervals were calculated using multivariable logistic regression. The relationship between perception of the dichotomized health status (good/very good) and the independent variables were analyzed by a multiple logistic regression model. For independent samples and quantitative variables were made descriptive statistics and univariate comparisons by t-student test, and for qualitative variables by chi-square test. The significance is set at p < 0.05.

      3. Results

      We analyzed data on donors who gave any type of blood donation between July 1, 2017 and January 31, 2018. During this time 2468 donors were enrolled at blood center, 1390 were regular repeat donors and 1078 were occasional donors (Fig. 1). The questionnaire was proposed to all regular repeat blood donors. 1102 did not wish or chose not to respond at survey for several reasons (i.e. lack of time or privacy) and 288 accepted, of which 83 were deferred from blood donation and were excluded from the analysis. Among the 205 included participants 68.3% (n = 140) were male, age ranged from 19 to 61 years with a mean age of 39.8 ± 11.1 SD and 31.7% (n = 65) were female age ranged from 20 to 62 years with a mean age of 37.7 ± 11.0 SD. In Table 1 we reported socio-demographics variables of interviewees. Blood donors were characterized by a high level of education and women had a higher degree than men (42.9% vs 44.6%). It was also asked how often the interviewees practiced activities organized sports such as running, walking, football, gym, swimming pool, or other. It turned out that 58.0% of them did not practice any sport while 42.4% did it (47.7% women vs 39.9% men). The favorite sport was running (12.7%), followed by the gym (10.7%), football (6.3%), swimming pool (5.9%), walk (5.9%) and only 0.5% cycling. Those who practiced sport every day were 17.4%, from one to three times a week made up 61.6% and 20.9% practiced sport only on weekends. Most of them (83.7%) practiced sport for an hour, 6.9% less than 1 h and 9.3% more than 2 h.
      Fig. 1
      Fig. 1Flow chart of blood donors for the assessment on nutritional habits and lifestyle.
      Table 1Socio-demographic characteristics of blood donors.
      CharacteristicsAnswersMaleFemaleTotalp-value
      n%n%n%
      Age62–473525.01726.25225.40.580
      46–324129.32335.46431.2
      31–186445.72538.58943.4
      Education levelMaster's degree6042.9%2944.6%8943.4%0.455
      High school diploma5740.7%2335.4%8039.0%
      Lower secondary school certificate2316.4%1218.5%3517.1%
      Elementary license00.0%11.5%10.5%
      Working situationSelf-employed107.1%23.1%125.9%0.126
      Employee5841.4%2030.8%7838.0%
      Worker2417.1%1015.4%3416.6%
      Student. unemployed. housewife4834.3%3350.8%8139.5%
      “How do you go to work?”On foot3526.1%2847.5%6332.6%0.031*
      By bicycle64.5%00.0%63.1%
      Public transport4936.6%1830.5%6734.7%
      Car/motorbike4332.1%1322.0%5629.0%
      Job typeSedentary10073.5%4166.1%14171.2%0.294
      Mild/moderate physical activity3425.0%2133.9%5527.8%
      Vigorous physical activity21.5%00.0%21.0%
      SportYes5539.9%3147.7%8642.4%0.292
      No8560.7%3452.3%11958.0%
      Sport typeFooting2115.0%57.7%2612.7%0.001*
      Walk21.4%1015.4%125.9%
      Football139.3%00.0%136.3%
      Gymnastic117.9%1116.9%2210.7%
      Swimming pool75.0%57.7%125.9%
      Bicycle10.7%00.0%10.5%
      Number of days sportEvery day1120.0%412.9%1517.4%0.016*
      Some day (2/3 days)2850.9%2580.6%5361.6%
      Only weekend1629.1%26.5%1820.9%
      Number of hour/day sport<159.1%13.2%67.0%0.039*
      14276.4%3096.8%7283.7%
      2814.5%00.0%89.3%
      SmokeYes6848.9%2843.1%9647.1%0.436
      No7151.1%3756.9%10852.9%
      Number of cigarettes/day<522.9%517.2%77.2%0.001*
      5–9811.8%1344.8%2121.6%
      10–143855.9%724.1%4546.4%
      15–191725.0%310.3%2020.6%
      >2034.4%13.4%44.1%
      * Significant at p < 0.05.
      Interestingly, a percentage of 90.7% of respondents assessed to follow a Mediterranean diet (Table 2). Almost all (97.1%) declared that they usually consume breakfast, preferring a lighter one. Lunch was usually consumed by almost all respondents (94.6%), eating preferentially vegetables (39.7%). The dinner consisted of meat/fish with vegetables and fruit (73.2%), followed by 23.9% which had a complete meal (from pasta to dessert). The alcohol consumption was also investigated and 33.8% (mainly men, 39.3%) that drank alcoholic beverages, preferring wine (51.4%) or beer (47.1%) and only 1.4% drinking strong alcoholic beverages.
      Table 2Nutritional habits and lifestyle of blood donors.
      ItemsAnswersMaleFemaleTotalp-value
      n%n%n%
      DietYes107.1%812.3%188.8%0.224
      No13092.9%5787.7%18791.2%
      Type of dietMediterranean12992.1%5686.2%18590.7%0.222
      Vegan42.8%34.6%73.4%
      Vegetarian53.6%57.7%104.9%
      Gluten-free00.0%11.5%10.5%
      Low carb21.4%00.0%21.0%
      Food intoleranceYes32.1%11.5%42.0%0.771
      No13797.9%6498.5%20198.0%
      Breakfast placeHome8560.7%5787.7%14269.3%0.001*
      Bar3827.1%710.8%4522.0%
      Work117.9%11.5%125.9%
      Without breakfast64.3%00.0%62.9%
      Breakfast typeAbundant4835.8%913.8%5728.6%0.004*
      Light5742.5%4467.7%10150.8%
      Only snacks10.7%00.0%10.5%
      Only drinks2820.9%1218.5%4020.1%
      Morning snackYes5438.6%4366.2%9747.3%0.001*
      No8661.4%2233.8%10852.7%
      Type of morning snackDrink1629.6%12.3%1717.5%0.001*
      Snack1222.2%614.0%1818.6%
      Sandwiches/pizza713.0%49.3%1111.3%
      Yogurt/fruit1935.2%3274.4%5152.6%
      Lunch placeHome4632.9%3553.8%8139.5%0.027*
      Bar/restaurant2820.0%710.8%3517.1%
      Work5942.1%1929.2%7838.0%
      Without lunch75.0%46.2%115.4%
      Lunch typeComplete meal2821.2%914.5%3719.1%0.026*
      Pasta2821.2%1930.6%4724.2%
      Second1712.9%1625.8%3317.0%
      Vegetables5944.7%1829.0%7739.7%
      Afternoon snackYes2517.9%3858.5%6330.7%0.001*
      No11582.1%2741.5%14269.3%
      Type of afternoon snackDrink1040.0%12.6%1117.5%0.001*
      Snack416.0%37.9%711.1%
      Sandwiches/pizza00.0%12.6%11.6%
      Yogurt/fruit1144.0%3386.8%4469.8%
      DinnerComplete meal4532.1%46.2%4923.9%0.002*
      Pasta21.4%11.5%31.5%
      Second9165.0%5990.8%15073.2%
      Vegetables10.7%11.5%21.0%
      Pizza/sandwiches10.7%00.0%10.5%
      Drinking water (liter/die)0.5117.9%46.2%157.3%0.001*
      110373.6%2640.0%12962.9%
      >22618.6%3553.8%6129.8%
      Alcohol consumptionYes5539.3%1421.9%6933.8%0.015*
      No8560.7%5078.1%13566.2%
      Alcohol typeBeer2647.3%746.7%3347.1%0.866
      Wine2850.9%853.3%3651.4%
      Spirit11.8%00.0%11.4%
      * Significant at p < 0.05.
      In Fig. 2 the difference of B.M.I. between men and women were reported that resulted significant (p < 0.001). Data showed that most women had a normal weight (76.9%), whereas half the men resulted prevalently overweight (50.7%). No significant correlation was found between the biochemical and hematological parameters and BMI (data not showed).
      Fig. 2
      Fig. 2Distribution of BMI in men and women. *Significant at p < 0.001.
      In Table 3 we have summarized the answers about perception of own health state. Two questions were asked to blood donors regarding the perception of own health state (“In general, would you say that your health is very good/good/bad/very bad?”) and the number of days (in the last month) in which they had health problems. Our survey showed that 84.4% of the participants evaluated their health as “good”, without gender difference (men, 86.4% vs women, 80.0%). Besides, 14.6% reported their health as “very good”. In addition, two other questions were asked to blood donors regarding the number of days in which they did not feel well for mental and/or psychological reasons and the number of days in which they had limitations in the usual activities. Most participants (93.7%) answered that they didn't feel bad in the last month for mental or psychological reasons against 6.3% who felt sick in a range of 1–6 days. Finally, the self-perceived well-being by blood donors has been correlated to some aspects (sex, education level, working situation, sport, smoke, BMI) through a multiple logistic regression. No variable examined is related to perceived wellbeing (data not shown).
      Table 3Perception of own health state.
      ItemsAnswersMaleFemaleTotalp-value
      n%n%n%
      Perception of own health stateGood12186.4%5280.0%17384.4%0.477
      Very good1812.9%1218.5%3014.6%
      Not good10.7%11.5%21.0%
      Number of days with limitation due to physical reasons012186.4%5381.5%17484.9%0.363
      1–61913.6%1218.5%3115.1%
      Number of days with limitation due to mental reasons013193.6%6193.8%19293.7%0.940
      1–696.4%46.2%136.3%
      Number of days with limits in usual activities013092.9%6396.9%19394.1%0.249
      1–6107.1%23.1%125.9%
      * Significant at p < 0.05.

      4. Discussion

      The major finding of the present study is a significant higher incidence of overweight and obesity (50.7% and 20.0%) in males blood donors compared to women. Despite this, we observed that only 1.0% had a perception of own health state as “bad”, whereas the remaining part of participants have reported to feel “good” or “very good”. A major limitation the few respondents and particularly very few women in the study.
      The population should be aware that balance between energy consumption and expenditure is important for health, as is the quality of nutrient intake. Different aspects of society negatively affect lifestyle as the introduction of “fast food”, which led to a food style characterized by very generous portions (super-sizing) and low nutritional value or the consumption of highly energetic food (high calorie or high sodium content) and sugary drinks (highly sugary or alcoholic).
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      Although most of the interviewees in our study could distinguish the influence of healthy and unhealthy habits on their lives, it seemed to not positively impact on their weight. It also has shown their high interest on eating habits and most of the respondents were non-smokers and usual non-alcohol drinkers. Most of women had normal weight, probably as consequence of major attention to lifestyle, practicing sport and not smoking. In addition, sedentary life, working situation, lack of interest on physical activities (particularly regular exercise and healthy walk) play a crucial role in the BMI differences observed between men and women.
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      Subjective wellbeing, health, and ageing.
      However, there are only few studies on the association of psychological well-being to nutritional status. In Italy, from a survey on how the population judges own state of health emerged 7 out of 10 people considered their state of health “positive” (declaring they feel good/very good) (Passi data from 2014 to 2017). Approximately 3% of the population reported that they feeling bad/very bad; the remaining part declared to feel “good”. It has been noted that young people, men, people with a higher socio-economic level, for education or economic conditions, foreign citizens other than Italians and those who are free from severe pathological conditions are more satisfied with their health.
      It has been demonstrated that weight misperceptions defined as discrepancies between objective indicators of weight and individuals’ perceptions of their weight status appear common in the population.
      • Patte K.A.
      • Laxer R.
      • Qian W.
      • Leatherdale S.T.
      A cross-sectional analysis of weight perception and weight-control intentions among secondary school students in the COMPASS study.
      ,
      • Jackson S.E.
      • Johnson F.
      • Crocker H.
      • Wardle J.
      Weight perceptions in a population sample of English adolescents: cause for celebration or concern?.
      Recently researchers have expressed concerns that obeses underestimate their weight lacking motivation to engage health behavioral changes (despite to achieve misperceptions of being overweight in the eating disorder).
      • Jackson S.E.
      • Johnson F.
      • Crocker H.
      • Wardle J.
      Weight perceptions in a population sample of English adolescents: cause for celebration or concern?.
      ,
      • Deschamps V.
      • Salanave B.
      • Chan-Chee C.
      • Vernay M.
      • Castetbon K.
      Bodyweight perception and related preoccupations in a large national sample of adolescents.
      According to these data, we noted a percentage of 37.07% normal weight, 34.15% overweight and 13.17% obese blood donors that feel good (data not shown).
      Finally, blood centers can play a public health role in overweight and obesity surveillance but we are not aware of published data on BMI distributions among blood donors in the whole region.
      This demographic study has some limitations based on the small number of recruited blood donors and the characteristics of the participants. Data may not be comparable to national statistics due to the nature of the study design. Furthermore, results may not be transferable to other populations. No information on portion sizes of food frequency items was obtained, nor was it possible to adjust scores by energy intake. Besides, there was limited dietary information on unsaturated fats and meat alternatives, e.g., nuts, seeds, beans/legumes, tofu, or eggs.

      5. Conclusion

      This demographic study has provided an understanding of health knowledge and attitude of the blood donors that might affect their health and life expectancy. Our initial idea was that regular blood donors would be more attentive to lifestyle and nutritional habits, but our results showed exactly the contrary. In particular, males are prevalently overweight or obese showing that they do not eat a balanced healthy nutrition. The collected data showed that included women have a better knowledge of the nutritional properties of food and consequently adopt a more balanced and proper diet. Furthermore, it is clear that they are well aware about the relationship between lifestyle and health putting into practice their information. Moreover female donors pay more attention to eating behavior and physical exercise. Unfortunately, the survey structure, of observational nature, does not make it possible to establish whether women are more alert to health to participate more in donation programs or if, on the contrary, the status of regular donor could help the improvement of knowledge and healthy lifestyle.

      Declaration of competing interest

      The authors declare that they have no conflict of interest.

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