Employee Involvement and Participation as a Function of Labor Relations and Human Resource Management: Evidence from Greek Subsidiaries of Multinational Companies in the Pharmaceutical Industry

Triantafillidou, Eleni; Koutroukis, Theodore

doi:10.3390/admsci12010041

Open AccessArticle

Employee Involvement and Participation as a Function of Labor Relations and Human Resource Management: Evidence from Greek Subsidiaries of Multinational Companies in the Pharmaceutical Industry

by

Eleni Triantafillidou

^*

and

Theodore Koutroukis

Department of Economics, Democritus University of Thrace, 69100 Komotini, Greece

^*

Author to whom correspondence should be addressed.

Adm. Sci. 2022, 12(1), 41; https://doi.org/10.3390/admsci12010041

Submission received: 4 February 2022 / Revised: 28 February 2022 / Accepted: 7 March 2022 / Published: 9 March 2022 / Corrected: 30 June 2022

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Abstract

:

Employee involvement and participation is part of Labor Relations and Human Resource Management. This study is to identify how and to what extent employee involvement and employee participation mechanisms are used in the Greek subsidiaries of multinational companies in the pharmaceutical industry. The issues examined in this study are the design of employee involvement and participation practices, the similarities and differences of employee participation practices in the group of companies internationally, corporate employee communication and consultation mechanisms, corporate policy towards trade unions and the EWC nature and agreements. The research method is qualitative with semi-structured interviews conducted with management executives, human resource management executives and the selected organizations participating in the study are active in the pharmaceutical industry and fall within the scope of Directive 2009/38/EC/16.5.2009 on the right of employees to information and consultation at Community-scale companies and groups of companies. The findings indicate that most of the participant companies when designing employee involvement and participation practices, consider a formal model of best practices that has been codified for all multinational companies. Regarding the global company’s policy on consultation and employee involvement most of the participant companies state that they provide a little more than the institutional framework requires. Nevertheless, management receives information about the activity and meetings of the EWC systematically at the time of EWC meetings. Increasing employee participation requires both management attention and initiatives on the part of employees.

Keywords:

employee participation; Labor Relations; Human Resource Management; European Works Councils

1. Introduction

At times, there are many definitions that refer to multinational organizations which characterize them as global, international, and transnational. There is no commonly accepted definition in the literature on the concept of “multinational enterprise”. There are several definitions that describe what characteristics a business should have to be considered a multinational. A multinational company is a company that operates in one country (the parent country) and produces products or services in one or more foreign countries (host countries) (Mondy and Noe 2005). According to the definition of Dunning and Lundan (2008, p. 3), “a multinational enterprise is an enterprise that conducts foreign direct investment and which owns, or controls, value-added activities in more than one country”. Moreover, a company that employs human resources in more than one country to produce its products and/or for the offer of its services is multinational (Kelly 2001). According to Dau (2013), multinationality refers to the degree to which an enterprise has international operations and is understood (1) in terms of location characteristics and knowledge of host market dynamics, (2) in terms of knowledge links that connect the network of international subsidiaries and the parent company in the geographical area and (3) in terms of organizational changes and strategic decisions taken by companies to develop their network of international subsidiaries.

International Human Resource Management (IHRM) is human resources management in multinational corporations and includes the planning, selection, training, evaluation of employees and management of employment relationships in companies that perform their functions internationally (Björkman and Welch 2015; Bos-Nehles et al. 2017).

The international HRM is called upon to face several challenges in recruiting and managing employees in distinct cultural and legal contexts (Leat 2012; Harzing and van Ruysseveldt 2004) without any prejudice and discrimination (Peráček 2021). According to Myloni et al. (2007), Human Resource Management is becoming increasingly important for multinational companies as it is an important mechanism for coordinating and controlling the international operations of companies. At the same time, HR is an important factor when multinational companies try to implement international strategies, mainly because of the different cultural and institutional context of each country where the multinational company operates (Belizón et al. 2016; Dalton and Druker 2012). The national reporting framework influences the way we manage human resources in different countries and multinationals are under pressure to adapt HR practices accordingly (Marginson et al. 2013).

This study identifies how and to what extent employee involvement and employee participation mechanisms are used in the Greek subsidiaries of multinational companies in the pharmaceutical industry. The issues examined in this study are the design of employee involvement and participation practices, the similarities and differences of employee participation practices in the group of companies internationally, the type of information provided to employees during the meetings with the management, the management policy towards union recognition, the trade union representative approach, the corporate policy towards trade unions, the corporate employee communication and consultation mechanisms, the global company’s policy on consultation and employee involvement, the impact of EU Directives (94/45/EC—2002/14/EC—2009/28/EC) on agreements with employees, the nature of EWC’s in the Organization, and the management interest on the activities and meeting of the EWC.

According to the research of Stavroulakis (2009), family businesses and SMEs that operate with traditional management methods dominate mainly the Greek business environment (for SMEs see also Charaia et al. 2021). However, a section of Greek companies has expanded its activities internationally. In recent years, many multinational subsidiaries have entered the Greek market, bringing general HR practices applied by the parent companies (Myloni et al. 2007). The main HR thematic categories in multinationals are (1) HR practices, (2) subsidiary and parent company relationships, (3) HR strategy and international business activities, (4) employment relationships, (5) organizational behavior, (6) culture studies, (7) comparative HR and (8) language and communication and international business (Cooke et al. 2019). The aim of the study is to examine employee participation and representation in multinational companies with a subsidiary in Greece that have a European Works Councils and are active in the pharmaceutical industry.

Employee participation is a set of practices aiming to achieve objectives. Employee participation can be direct or indirect through representative bodies such as trade unions, joint consultative committees and works councils (Aranea et al. 2021; Brewster et al. 2019; Koinig and Weder 2021). European Directives institutionalize indirect participation through European Works Councils (Franca and Pahor 2014). EWCs are information and consultation bodies representing the European employees of a multinational company (Leonardi 2016). European Union policy seeks to promote employee participation in the member states based on the twin concepts of industrial democracy and economic competitiveness through the European Directives. The outcomes of employee participation are organizational and individual (Park 2015).

Organizational outcomes include the improvement of labor productivity and organizational performance and individual outcomes include the improvement of employee wellbeing through organizational commitment, engagement, trust and justice (Uribetxebarria et al. 2021; Benn et al. 2015). The HR department is the intermediate link between employees and management. There are many theories concerning the role of HR in managing employee relations (Olšovská et al. 2015; Townsend et al. 2019). The role of HR is to facilitate employee participation through the planning, implementation, execution and assessment of HR policies and participation practices (Pender et al. 2018). There is empirical evidence that high degree of employee participation does not lead to desirable results without strategic and systematic HRM policies (Smith 2021)

Employee involvement and participation practices include: (1) direct downward communication (newsletters, email, intranet, and noticeboards); (2) direct two-way communication (team briefings, workplace meetings, staff newsletters, and the cascading of information via the management team); (3) direct upward feedback (problem-solving groups, and suggestion schemes); (4) direct financial participation (profit-related bonus schemes, deferred profit-sharing schemes, and employee share ownership schemes); (5) indirect participation (employee committees, employee representative structures, e.g., Trade Unions, Works Councils, and Joint Consultative Committees) (Gennard et al. 2016, pp. 201–2; Maagaf 2010; Dvorak and Civinskas 2022).

According to Drehmer et al. (2000), participation includes: career counseling, employee stock ownership, functional business skills training (accounting, finance, etc.), gain-sharing, group decision-making skills trainings, individual incentives job enrichment or redesign, merit pay, profit sharing, quality circles self-managing work teams, suggestion systems, survey feedback, team-building skills training and union management.

According to Cabrera et al. (2003), labor participation can take the form of various management practices, such as participatory management, employee participation programs, empowerment or democracy in the workplace. Each of these practices attempts to involve employees in the exchange of information and/or decision-making. Participation can be direct or indirect. In direct participation, employees participate directly in decisions and influence them, while indirect participation takes place through an intermediary body representing employees, such as workers’ councils or trade unions. Common forms of direct employee involvement include group updates, suggestion plans, job enrichment, job planning, stand-alone workgroups, quality of work life plans and behavioral surveys, while indirect forms include employee councils, trade unions and task forces (Brown et al. 2007; Butali and Njoroge 2018).

Cox et al. (2009), in their study, include ways to measure the breadth and depth of participation. The scope of Work participation refers to the number of different work participation practices shared in a workplace and the depth of work participation refers to the quality of work participation practices. The two ways in which we can measure the depth of work participation are: a. assessing how often a work participation practice takes place and b. how much time is given to employees for this practice. The measures proposed by the research are: 1. Group information; 2. Problem—solving groups; 3. Survey of opinions or attitudes of employees; 4. Information on investment plans; 5. Information on the financial situation of the company; 6. Information on the financial situation of the Organization; 7. Information on the staffing; 8. Existence of a joint advisory committee.

Wilkinson et al. (2013), propose an employee participation architecture. The dimensions of the proposed architecture include the level of work participation, the form of work participation, an example of work participation and the scope of the topics covered. The first level of participation is individual, the format is informal, examples of participation are conversations other than recording and emails and the issues covered are workload and personal issues. The second level of work participation is the work unit formal direct (through groups) the format is teamwork and participation in the work and the issues covered are functional issues. The third level of job involvement is the level of organization it includes a. Formal direct through cross-sectoral committees and employee health and safety surveys, customer interaction, employee satisfaction, profitability/efficiency, strategy and operational issues, and b. Formal indirect (through trade unions) through business negotiations and Joint Advisory Committees (JCCs) covering issues related to wages, working conditions and negotiation-related complaints.

Most researchers examine the elements that determine employee participation such as the degree of participation (the degree to which employees influence the final decision), the level of participation (the hierarchical level where participation takes place), the form of participation (direct, indirect, financial) and the scope of participation (the range of issues are discussed). We can divide research on employee participation into ten thematic categories that include (1) forms and practices of employee participation, (2) organizational performance (business performance, productivity, business success and competitive advantage), (3) linking employee participation to job satisfaction and (4) organizational commitment, (5) employee and management perceptions and attitudes towards employee participation, the relationship of employee participation to (6) change management, (7) working environment, (8) the staffing strategy (9) the financial crisis and (10) the outcomes and effectiveness of employee participation (Triantafillidou 2020, 2021).

Based on the above literature, the aim of the research is to examine how and to what extent employee participation practices are applied in multinational companies with a subsidiary in Greece that have EWC and are active in the pharmaceutical industry.

2. Materials and Methods

Examining the research approach, we evaluated three alternatives: quantitative, qualitative and mixed methods, with the qualitative method approach being considered to best meet the research design. Qualitative methods are preferred when the “how” and/or “why” questions are asked and when there are multiple sources of evidence (Yin 2003). The qualitative approach was considered appropriate to answer the research questions of the project, making it possible to understand the experiences and relationships of employees and Organizations in employee participation (Cajkova and Cajka 2021). To understand the factors that affect the effectiveness of employee participation and the perceived benefits and costs, the specific conditions and relationships related to this participation framework must be studied and analyzed, and a qualitative research strategy provides the tools to do so. In addition, the qualitative methodology is appropriate and used in several publications and dissertations on employee participation in multinationals (for example: Koutroukis 2004; Kerckhofs 2007; Kynighou 2010; Maagaf 2010; Suter 2008).

As evidenced by the objectives of the research, what is sought essentially requires an in-depth understanding of the implementation of employee participation in subsidiaries of multinational companies in Greece that are active in the pharmaceutical sector and have a European Works Council. A semi-structured questionnaire is used based on previous studies (Minbaeva and Navrbjerg 2011; Knudsen 2004) and 8 semi-structured interviews are conducted with management executives and human resource management executives.

The selection criterion of the Organizations taking part in the study is to belong to the pharmaceutical industry and to fall within the scope of Directive 2009/38/EC/6.5.2009 on the establishment of a European Works Council or a procedure in Community-scale undertakings and Community-scale groups of undertakings for the purposes of informing and consulting employees which was incorporated in the Greek legal order with Law 4052/2012 (Government Gazette 41/1.3.2012, vol. B). According to article 51 par. 1 of the Law 4052/2012 or the corresponding article 2 of Directive 2009/38/EC/6.5.2009:

(a)

Community-scale undertaking’ means any undertaking with at least 1000 employees within the Member States and at least 150 employees in each of at least two Member States;

(b)

A ‘group of undertakings’ means a controlling undertaking and its controlled undertakings;

(c)

‘Community-scale group of undertakings’ means a group of undertakings with the following characteristics:

-: At least 1000 employees within the Member States,
-: At least two group undertakings in different Member States,
-: At least one group undertaking with at least 150 employees in one Member State and at least one other group undertaking with at least 150 employees in another Member State.

For the purposes of the research, it was more effective and reliable to adopt a semi-structured approach based on a questionnaire, which aims to understand some basic information about the participants, the Organization, the employee participation practices adopted and the perceptions of management and employees regarding the outcomes of these practices. During the development of the questionnaire, an attempt was made to record formal and informal procedures and types of Human Resource Management (HRM). There were three groups of participants in the research study: the management, the HR department, and the employees. The participants in the management group were mostly senior executives. This study presents the research results of interviews with management and HR. Most of the interviews were conducted by telephone or via the internet due to the COVID-19 pandemic. In several interviews with the directors of HR and the top management, the participants were very willing to discuss, with the result that the interviews lasted longer than the 20-min schedule. The following table (Table 1) describes the scheduling of the interviews and specifically the first contact with the participants in the research, the date of the interview and the duration of the interview.

The table below (Table 2) presents the average and mean age and years of service of research participants both as a whole and by group—participation status (HR, management).

The Profile of the Subsidiaries of Pharmaceutical Multinationals Located in Greece

The Central Management of multinationals is in Luxembourg, Switzerland, Germany, and the UK, and for two multinationals it is in the USA. The profile of multinational subsidiaries operating in Greece is presented below (ICAP 2019).

M1: Founded in 1973. Produces pharmaceuticals in a unit of 7000 sq.m. and distributes the products of the German parent company, which are entirely original. Exports account for a large part of the total turnover.
Activity: Production of drugs. Representations, exclusive imports and wholesale trade of medicines and toothpaste.
Staff: 335 people
Turnover 2018: EUR 325.922.365

M2: Founded in 2000 and started full operations in 2003. In the same year its headquarters were moved and its name changed to today’s.
Activity: Production (contract for third parties) of pharmaceuticals and cosmetics. It deals with the production of pharmaceutical products on behalf of companies—its customers, the domestic market and abroad.
Staff: 1.135 people
Turnover 2017: EUR 125.629.948

M3: Founded in 1971 in Athens. In 2002 the titleholder absorbed a company and its name changed to today.
Activity: Exclusive imports, production (contract) and wholesale of medicines. Countries of import: Ireland, United Kingdom, France, and Germany.
Staff: 210 people
Turnover 2018: EUR 132.069.800

M4: Founded in 1979, based in Chalandri—Athens. In 1995 its name was changed to today and its headquarters were moved to the current address.
Activity: Representations, exclusive imports and wholesale trade of medicines. Countries of Importation: Belgium, Switzerland, and Ireland. It is jointly controlled by an American company.
Staff: 165 people financial data
Turnover 2018: EUR 102.144.591

M5: Founded in 1967. In 1997 its name changed to today’s.
Activity: Production (contract), representations, exclusive imports and trade of medicines. Countries of import: Germany, and Switzerland.
Staff: 430 people
Turnover 2018: EUR 310.566.097

M6: Founded in 1960, based in Athens. In 2001 the holder took over the production, exclusive imports and wholesale trade of medicines, para-pharmaceuticals and toothpaste.
Activity: Production (contract), representations, imports and wholesale trade of medicines and veterinary preparations. Countries of import: USA, France, Germany, and Belgium.
Staff: 300 people
Turnover 2018: EUR 226.980.853

3. Results

Regarding the vision, mission, and culture of the Organizations and if they differ in the countries where the multinational is active, the management unanimously answers that they are common and united in all the countries where the multinational is active. Regarding the current challenges facing the Organizations, they answered that it is resources as everyone is trying to limit resources and the costs related to health is an expense that is trying to be limited. In general, “there is no balance between the reward of innovation—you invest in new products, but you do not know if they will return to the Organization, there is a tendency for global cost containment.” One of the companies participating in the study is in the process of reconstruction, it came out of a difficult economic period and is planning to invest in its infrastructure and stabilize its future. It is also noted that multinational companies are constantly changing to survive. Regarding whether the employee participation practices add value or are simply decorative, the management executives answer that “they add value because if you help a person, you make a difference—if you do it to a greater extent the greater the result you can have but and one person to help it counts. Employee participation adds value. It is a voice that has its weight and value.” Whether participation slows down the decision-making process, they stated that the delay that may occur is in execution, implementation of the decision, not in the decision making.

To whether there are meetings of management—employees’ representatives for information and consultation and regarding the existence of a management policy for trade unions and the relationship between management and union—representatives of employees and management executives answered:

“There has been a trade union since the company was founded, every time issues are created, we see each other with the management, we negotiate, we seek the solution of problems, lately two-month meetings are established regardless of whether or not there are issues to discuss and see any problems that they also exist to inform us about various other issues, about the developments, regardless of the intermediates that may occur and that a more urgent meeting is needed”.

“There is individual communication with the management and meetings with the trade union representatives. Regarding the representative in the EWC, I know nothing about him. No one has informed us, there is no official information”.

“In Greece, the EWC probably can not influence decision-making, it may in other countries”.

“There are two active unions, we talk every month as planned, we have a constant communication, we consult them, for example, to manage the coronavirus crisis we considered it expedient to take a form to record close contacts if someone is positive in covid to know who he remembered with whom he went. Before making the decision, we called the trade union, we asked the opinion of the trade union, an open communication and procedure is followed on labor relations—we are taking a significant step towards protecting the labor rights. In the EWC, the majority are Greeks, there is a strong Greek presence. I have an archive of our old conversations with the EWC, organized by the Italian colleague HR, it is an excellent opportunity for employee representatives to get ideas and talk to each other. The EWC is a voice. There is a European Human Resources Management policy. You deal with things in common. We are seeing things more in common. The business complies with the law and goes one step further. Employee Participation practices are part of the Organization’s strategy. They are part of the mentality, part of our philosophy, of our culture”.

To the question how often participation programs are reviewed and redesigned and how the effectiveness of an employee participation program is evaluated they answered that “European and national legislation is applied and there is no model of the company to be designed” and in two companies they are examined with indicators in the annual surveys.

To the question of whether the company will expand or deepen the employee participation practices in the future, the answer was that “they will remain stable”, “yes we want them to expand, but COVID-19 does not help”, “they will remain the same but they can have other forms i.e., there is research on global employee satisfaction and assessment of executives, managers by employees and this will remain a practice as it gives the employee the impression that his voice is heard but it may change the way it is done.

The next section provides the answers given by HR executives regarding employee participation practices in the Greek subsidiaries of multinationals in the pharmaceutical sector.

When designing employee involvement and participation practices, Organization considers for most of the participant companies a formal model of best practices that has been codified for all multinational companies and for a part of them specific practices followed in the other companies of the multinational (Table 3).

Employee participation practices in the group’s companies internationally are similar for all the companies in the group for 2 out of 5 of the participant companies, are almost similar but with some differences in the various subsidiaries for 2 out of 5 of the participant companies and are quite different in different subsidiaries for 1 out of 5 of the participant companies (Table 4).

Regarding the type of information provided to employees during the meetings with management 4 out of 5 participant companies provide information to employees during the meetings with management concerning the staffing plans of the multinational group, 3 out of 5 participant companies provide information to employees during the meetings with management concerning the staffing plans of the company, 3 out of 5 participant companies provide information to employees during the meetings with management concerning the investment plans of the multinational group, 2 out of 5 participant companies provide information to employees during the meetings with management concerning the investment plans of the company, 2 out of 5 participant companies provide information to employees during the meetings with management concerning the financial position of the multinational group and 2 out of 5 participant companies provide information to employees during the meetings with management concerning the financial position of the company (Table 5).

According to HR departments, the approach that the trade union representatives adopt is a cooperative approach for 2 out of 5 participant companies and for the 3 out of 5 of the participant companies it depends on the issue. None of the HR departments stated that trade union representatives adopt an adversarial approach (Table 6).

For 2 out of 5 participant companies, there is no corporate policy towards trade unions and for the 3 out of 5 participant companies, the local management follows the local practice in the industry (Table 7).

Regarding the employee communication and consultation mechanisms for the 2 out of 5 participant companies’ emphasis is placed on direct communication and consultation, for 3 out of 5 participant companies equal emphasis is placed on both direct and indirect communication and consultation and none of the companies stated that emphasis is placed only on indirect communication and consultation through representatives (Table 8).

Regarding global companies’ policies on consultation and employee involvement 1 out of 5 participant companies states they clearly provide significantly more than the institutional framework requires, 1 out of 5 participant companies state they provide the minimum possible compliance with the legal framework for participation and consultation and 3 out of 5 participant companies state they provide a little more than the institutional framework requires (Table 9)

The EU Directives (94/95/ΕC—2002/14/ΕC—2009/38/ΕC) on information and consultation prompted changes in agreements with employees for 2 out of 5 participant companies, whereas nothing changed for the 3 out of 5 participant companies (Table 10).

Regarding the nature of EWCs in the Organization for 1 out of 5 participant companies, management provides the least possible information for reasons of compliance with the legislation, there is no dialogue with the employees’ representatives and no influence on their decision making and for the 4 out of 5 of the participant companies, management provides more information than is required to comply with the law, there is a substantial dialogue with employee representatives on some issues and limited influence on decision-making. None of the companies stated that management provides much more information than is required to comply with the law. There is a meaningful dialogue with employees’ representatives on many issues and decisive influence on decision making (Table 11).

According to the answers provided by HR departments to the question of whether management receives information about the activity and meetings of the EWC, 4 out of 5 participant companies state that management receives information about the activity and meetings of the EWC systematically at the time of EWC meetings, 1 out of 5 participant companies stated that management receives information about the activity and meetings of the EWC periodically on an “as necessary” basis and none of the companies stated that management receives little or no information about the activity and meetings of the EWC (Table 12).

4. Conclusions

The table below depicts the overall assessment of employee participation for the Greek subsidiaries of multinational companies in the pharmaceutical industry. Most of the Organizations adapt employee participation practices in the form of downward communication, two-way communication, upward communication, financial participation and representative participation. The degree of influence is high for the form of downward communication, medium for the form of two-way communication and low for the other form of participation. Regarding the level of participation, it is medium for the forms of downward communication and the representative participation and low for the other forms of participation, so the general level of employee involvement is limited more to operational issues and less to the issues of strategic level (Table 13).

When designing employee involvement, and participation practices, Organization most companies consider a formal model of best practices that has been codified for all multinational companies and employee participation practices in the group’s companies internationally are similar or almost similar in the various subsidiaries of the participant companies. The type of information is provided to employees during the meetings with management is about the staffing plans of the multinational group and the staffing plans of the company, the investment plans of the multinational group and the investment plans of the company, the financial position of the multinational group and the financial position of the company. According to HR departments the approach that the trade union representatives adopt usually depends on the issue and none of the HR departments stated that trade union representatives adopt an adversarial approach. For most companies, there is no corporate policy towards trade unions and emphasis is placed on both direct and indirect communication and consultation and most of the participating companies state that regarding the global company’s policy on consultation and employee involvement they provide a little more than the institutional framework requires. For most companies, management provides the least possible information for reasons of compliance with the legislation, there is no dialogue with the employees’ representatives and no influence on the decision making. Management receives information about the activity and meetings of the EWC systematically at the time of EWC meetings. Increasing employee participation requires both management attention and initiatives on the part of employees. Professionals in the field of Employee Relations and HRM need to facilitate employee participation through the planning, implementation, execution and assessment of HR strategy and systematic HRM policies aiming at participation practices leading to desirable results.

This study is an attempt to explore issues of employee involvement and participation in subsidiaries of multinational companies in Greece that are active in the pharmaceutical sector and have a European Works Council. One of the limitations of this study is its orientation in one country and in one industry because there were objective difficulties for the researchers to expand the research in more countries and industries. We recommend that future research could be transnational and examine issues of employee participation in the subsidiaries of one multinational in different countries considering the aspects of employees, management, HR executives and EWC representatives. Although the findings of this research cannot provide generalizations for the whole of multinationals it can provide a useful perspective for managers, academics and researchers in the field of Employee Relations and Human Resource Management.

Author Contributions

Conceptualization, E.T. and T.K.; methodology, E.T. and T.K.; validation, E.T. and T.K.; formal analysis, E.T. and T.K.; investigation, E.T. and T.K.; resources, E.T. and T.K.; data curation, E.T. and T.K.; writing—original draft preparation, E.T. and T.K.; writing—review and editing, E.T. and T.K.; visualization, E.T. and T.K.; supervision, E.T. and T.K.; project administration, E.T. and T.K.; funding acquisition, E.T. and T.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are part of a PhD study and are available on request from the corresponding author.

Conflicts of Interest

The authors declare no conflict of interest.