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Study Design: Single institution observational study., Objectives: To investigate the ceiling and floor effects of the Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (BESTest), and Brief-BESTest, as well as to determine the intra- and inter-rater reliabilities and minimal detectable change (MDC) of the Mini-BESTest and Brief-BESTest in patients with acute and subacute incomplete cervical spinal cord injury (SCI) classified as AIS D., Setting: Advanced critical care center of our university hospital., Methods: Twenty patients with incomplete cervical SCI who could stand without assistance were recruited. The floor and ceiling effects were evaluated by plotting histograms from the distribution of scores on the BBS, Mini-BESTest and Brief-BESTest, and calculating skewness. The Mini-BESTest and Brief-BESTest were evaluated and videotaped simultaneously, and intra- and inter-rater reliabilities were assessed. The MDC was also calculated., Results: The skewness of the BBS was -1.57, and the full score was 35%, indicating a ceiling effect. However, no ceiling or floor effect was observed for the Mini-BESTest and the Brief-BESTest. Intraclass correlation coefficients for intra-rater and inter-rater reliabilities were 0.98 and 0.97 for the Mini-BESTest and Brief-BESTest, respectively. Individual item reliability was moderate or better for the Mini-BESTest and excellent or better for the Brief-BESTest. The MDC of total scores ranged 3.14-3.84 and 2.92-3.60 for the Mini-BESTest and Brief-BESTest, respectively., Conclusions: The Mini-BESTest and Brief-BESTest are reliable assessment tools for patients with acute and subacute incomplete SCI classified as AIS D. Clarified error ranges aid in estimating the treatment effect on balance abilities., Competing Interests: Competing interests: The authors declare no competing interests. Ethical approval: This study was conducted after obtaining approval (S22-079) from the Research Ethics Committee of the Saitama Medical University Hospital., (© 2024. The Author(s), under exclusive licence to International Spinal Cord Society.)

Background: Assessing changes in quality of life in patients with hay fever-related allergic conjunctivitis requires validated and clinically meaningful metrics. A minimal clinically important difference (MCID) that can be applied to assess Domain II of the Japanese Allergic Conjunctival Disease Quality of Life Questionnaire (JACQLQ) in a smartphone app setting has yet to be determined., Objective: This cross-sectional observational study aimed to determine MCIDs for the app-based JACQLQ in assessing hay fever-related allergic conjunctivitis., Methods: This study used data from a crowdsourced, cross-sectional, observational study conducted via the smartphone app "AllerSearch" between February 1, 2018, and May 1, 2020. Participants were recruited through digital media and social networking platforms and voluntarily provided electronic informed consent. Participants completed the JACQLQ, which includes items on daily activity and psychological well-being, as well as a visual analog scale to measure stress levels related to hay fever. Data were collected through the app, ensuring comprehensive user input. MCIDs were determined using both anchor- and distribution-based methods. The face scale of the JACQLQ Domain III and stress level scale for hay fever were used as anchors to estimate the MCID; ranges were derived from these MCID estimates. In the distribution-based method, MCIDs were calculated using half the SD and SE of the JACQLQ Domain II scores. SEs were derived from the intraclass correlation coefficient of an app-based JACQLQ test-retest reliability metric., Results: A total of 17,597 individuals were identified, of which 15,749 individuals provided electronic consent. After excluding those with incomplete data, 7590 participants with hay fever were included in the study (mean age 35.3, SD 13.9 years; n=4331, 57.1% of women). MCID ranges calculated using the anchor-based method were 1.0-6.9, 1.2-5.6, and 2.1-12.6 for daily activity, psychological well-being, and total JACQLQ Domain II scores, respectively. Using the distribution-based method, the intraclass correlation coefficients were odds ratio (OR) 0.813 (95% CI 0.769-0.849) for daily activity, OR 0.791 (95% CI 0.743-0.832) for psychological well-being, and OR 0.841 (95% CI 0.791-0.864) for total JACQLQ Domain II scores. In addition, the distribution-based method resulted in 2 MCIDs based on half the SD and SE of measurement for daily activity (4.8 and 4.2), psychological well-being (3.4 and 3.1), and total JACQLQ Domain II (7.8 and 6.4) scores. The final suggested MCID ranges for daily activity, psychological well-being, and total JACQLQ Domain II scores were 4.2-6.0, 3.1-4.7, and 6.4-10.5, respectively., Conclusions: MCID ranges for the JACQLQ estimation could help to standardize the app-based quality of life assessment for patients with hay fever-related allergic conjunctivitis. These MCIDs enhanced the precision of remote symptom monitoring and facilitated timely, data-driven interventions, ultimately improving the overall management and outcomes of allergic conjunctivitis through mobile health platforms., (©Ken Nagino, Jaemyoung Sung, Akie Midorikawa-Inomata, Yasutsugu Akasaki, Takeya Adachi, Nobuyuki Ebihara, Ken Fukuda, Atsuki Fukushima, Kenta Fujio, Yuichi Okumura, Atsuko Eguchi, Keiichi Fujimoto, Hurramhon Shokirova, Alan Yee, Yuki Morooka, Tianxiang Huang, Kunihiko Hirosawa, Shintaro Nakao, Hiroyuki Kobayashi, Takenori Inomata. Originally published in JMIR Formative Research (https://formative.jmir.org), 26.11.2024.)

Society 5.0, proposed as part of the 5th Science and Technology Basic Plan by Japan's National Institute of Advanced Industrial Science and Technology, is a human-centered society where cyberspace and physical space are integrated, to resolve social challenges and promote economic growth. In Society 5.0, medicine will undergo extensive digital transformation (DX), and digital health technology is expected to expand markedly, becoming part of routine clinical practice. Prompt diagnosis of dry eye disease (DED) and uninterrupted monitoring of such patients with healthcare barriers is currently an unmet need. DX of DED evaluation and management can boost the current quality of DED care. Software as Medical Devices (SaMDs), i.e., software programs developed through evidence-based research to provide diagnostic, therapeutic, and preventive services, and particularly medical devices based on smartphone applications (apps), have attracted attention. We have striven to actualize the DX of ophthalmic care and evaluation, denoted by our ongoing development of SaMDs to assist DED diagnosis. To illustrate healthcare using the Internet of Medical Things, we here present the research and development process of our smartphone app-based SaMD for DED diagnosis assistance., Competing Interests: The DryEyeRhythm application was created using Apple's ResearchKit (Cupertino, CA, USA) along with OHAKO, Inc. (Tokyo, Japan) and Medical Logue, Inc. (Tokyo, Japan). TI reports non-financial support from Lion Corp. and Sony Network Communications Inc.; grants from Johnson & Johnson Vision Care Inc., Yuimedi Inc., ROHTO Pharmaceutical Co. Ltd., Kobayashi Pharmaceutical Co. Ltd., Kandenko Co. Ltd., and Fukoku Co. Ltd.; and personal fees from Santen Pharmaceutical Co. Ltd., InnoJin Inc., and Ono Pharmaceutical Co. Ltd., outside the submitted work. YO, KN, and AMI received personal fees from InnoJin Inc., outside the submitted work. SN report grants from Kowa Co. Ltd.; Mitsubishi Tanabe Pharma Corp.; Alcon Japan, Ltd.; Santen Pharmaceutical Co. Ltd.; Machida Endoscope Co. Ltd.; Wakamoto Pharmaceutical Co. Ltd.; Bayer Yakuhin Ltd.; Senju Pharmaceutical Co. Ltd.; Nippon Boehringer Ingelheim Co. Ltd.; Chugai Pharmaceutical Co. Ltd.; Hoya Corp.; and Novartis Pharma KK, outside the submitted work. The remaining authors have no conflicts of interest to declare., (© 2024 The Juntendo Medical Society.)

Purpose: Long-term ramifications of the coronavirus disease 2019 pandemic on various care-seeking characteristics of patients with diabetic retinopathy remain unclear. This study aimed to identify risk factors for dropout from regular fundus examinations (RFEs) in patients with diabetic retinopathy in Japan., Methods: We extracted demographic and health checkup data (April 2018 to March 2021) from the JMDC database. Patients with diabetes identified using diagnosis-related and medication codes were included. The dropout and continuation groups included patients who discontinued and continued to undergo RFEs during the coronavirus disease 2019 pandemic, respectively., Results: The number of RFEs was significantly lower during the mild lockdown period (April and May 2020) than during the prepandemic period. Of the 14,845 patients with diabetes, 2333 (15.7%) dropped out of RFEs during the pandemic, whereas before the pandemic, of the 11,536 patients with diabetes, 1666 (14.4%) dropped out of RFEs (P = 0.004). Factors associated with dropout in the multivariate logistic regression analysis included younger age, male sex, high triglyceride levels, high γ-glutamyl transpeptidase levels, smoking habit, alcohol consumption, weight gain of more than 10 kg since the age of 20 years, and certain stages of lifestyle improvement. Factors associated with continuation included low body mass index and high glycosylated hemoglobin levels., Conclusions: Our findings can assist in identifying patients with diabetes at risk of dropout., Translational Relevance: These results have implications for public health and identifying patients with diabetes at risk of dropout. Education and tailored monitoring regimens could be pivotal role in fostering adherence.

Background: Hay fever (HF) presents with various symptoms, including allergic conjunctivitis and rhinitis, and requires cross-organ treatment. This study assessed the impact of the coronavirus disease 2019 (COVID-19) pandemic on HF treatment trends., Methods: This retrospective cohort study utilized data from the JMDC database collected between January 2018 and May 2021. Patients with HF were identified based on the relevant International Classification of Diseases 10th Revision diagnosis codes and the prescription of HF-related medications. The treatment approaches were compared during the cedar and cypress pollen allergy season (January to May in Japan) before and during the COVID-19 pandemic (2018 and 2019, and 2020 and 2021, respectively)., Results: This study included 2,598,178 patients with HF. The numbers of prescribed HF-related claims in 2018, 2019, 2020, and 2021 were 3,332,854, 3,534,198, 2,774,380, and 2,786,681 times, respectively. Oral second-generation antihistamine prescriptions decreased by >10% from 2019 to 2020, with a <10% change in the subsequent year. Anti-allergic eye drop prescriptions also decreased by >10% from 2019 to 2020 but increased by >10% from 2020 to 2021. Compared with 2018, 2019, and 2020, the number of claims in the rhinitis symptoms dominant group was significantly decreased in 2021 (p < 0.001, all). In contrast, the number of claims in the eye symptoms dominant group and the rhinitis and eye symptoms dominant group increased in 2021 compared with that in 2018, 2019, and 2020 (p < 0.001, all)., Conclusion: Changes in HF treatment and related outcomes could be attributed to lifestyle modifications resulting from the COVID-19 pandemic. Measures, such as limiting outdoor activities and adopting mask-wearing practices may have influenced HF symptoms, preventive behaviors, and the overall approach to treating HF., (© 2024 The Author(s). Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.)

Purpose: This study aimed to compare subjective allergic conjunctivitis symptoms and anti-allergic eye drop use patterns between antihistamine-releasing contact lens users and daily disposable soft contact lens users during Japan's hay fever season., Methods: This web-based retrospective cohort study included daily disposable soft contact lens or antihistamine-releasing contact lens users with a history of seasonal allergic conjunctivitis who regularly used daily disposable soft contact lenses since the previous year. The total ocular symptom score (range 0-20) based on 5-item questionnaire scores and time from the start of the hay fever season to the initiation of anti-allergic eye drop treatment were compared between antihistamine-releasing contact lens users and daily disposable soft contact lens users., Results: The study included 24 participants: 17 using daily disposable soft contact lenses and 7 using antihistamine-releasing contact lenses. Antihistamine-releasing contact lens users experienced a greater reduction in total ocular symptom score from 2021 to 2022 compared with daily disposable soft contact lens users (mean total ocular symptom score [standard deviation]: daily disposable soft contact lens: -0.65 [1.4], antihistamine-releasing contact lens: -4.7 [3.6]; n = 24; Mann-Whitney U test, P  = 0.010). Fourteen daily disposable soft contact lens users and five antihistamine-releasing contact lens users eventually required anti-allergic eye drops. Kaplan-Meier analysis revealed a significant delay in the initiation of anti-allergic eye drop treatment among those using antihistamine-releasing contact lenses compared with those using daily disposable soft contact lenses (median days, daily disposable soft contact lenses: 19 days, antihistamine-releasing contact lens: 57 days; n = 24; log-rank test, P  = 0.045)., Conclusions: Antihistamine-releasing contact lenses can potentially mitigate worsening ocular allergic responses during the hay fever season when used appropriately as a preventive measure., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Takenori Inomata reports equipment, drugs, or supplies was provided by Lion Corporation. Takenori Inomata reports equipment, drugs, or supplies was provided by Sony Network Communications Inc. Takenori Inomata reports financial support was provided by Kandenko, Co., Ltd., Johnson & Johnson K.K. Vision Care Company, Yuimedi, Inc., Rohto Pharmaceutical Co., Ltd., Kobayashi Pharmaceutical Co., Ltd., and Fukoku Co., Ltd. Takenori Inomata reports financial support was provided by 10.13039/501100004286Santen Pharmaceutical Co., Ltd., InnoJin, Inc., and Ono Pharmaceutical Co., Ltd. Takenori Inomata reports a relationship with InnoJin, Inc that includes: equity or stocks. Shintaro Nakao reports financial support was provided by 10.13039/100015993Kowa Company Ltd., Mitsubishi Tanabe Pharma Corporation, Alcon Japan, Ltd., Santen Pharmaceutical Co., Ltd., Machida Endoscope Co., Ltd., Wakamoto Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., Senju Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Chugai Pharmaceutical Co., Ltd., Hoya Corporation, and Novartis Pharma K.K., outside the submitted work. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Competing Interests: Conflicts of Interest: Inomata T, reports non-financial support from Lion Corporation and Sony Network Communications Inc., grants from Johnson & Johnson Vision Care, Inc., Kandenko, Co., Ltd., Yuimedi, Inc., Rohto Pharmaceutical Co., Ltd., Kobayashi Pharmaceutical Co., Ltd., Kandenko Co., Ltd., and Fukoku Co., Ltd., personal fees from Santen Pharmaceutical Co., Ltd., InnoJin, Inc., and Ono Pharmaceutical Co., Ltd., outside the submitted work; Okumura Y and Nagino K, report personal fees from InnoJin, Inc., outside the submitted work; Nakao S, reports grants from Kowa Company. Ltd., Mitsubishi Tanabe Pharma Corporation, Alcon Japan, Ltd., Santen Pharmaceutical Co., Ltd., Machida Endoscope Co., Ltd., Wakamoto Pharmaceutical Co., Ltd., Bayer Yakuhin, Ltd., Senju Pharmaceutical Co., Ltd. Nippon Boehringer Ingelheim Co., Ltd., Chugai Pharmaceutical Co., Ltd., Hoya Corporation, and Novartis Pharma K.K., outside the submitted work; Hirosawa K, None; Sung J, None; Morooka Y, None; Huang T, None; Akasaki Y, None; Omori K, None.

Introduction: Studies investigating the role of urinary tract abnormalities in the development of catheter-associated urinary tract infections (CAUTI) in young children are limited. Thus, in the present study, we aimed to determine whether there is an association between CAUTI and urinary tract abnormalities., Methods: We performed abdominal imaging studies on all patients aged <6 years with CAUTI admitted to the pediatric intensive care units (PICU) and high care unit (HCU) at Keio university or Fukuoka Children's Hospital from April 1, 2018 to July 31, 2022. Among 40 children who developed CAUTI, 13 (33 %) had abnormal urogenital images. Further, two case-control studies were conducted before and after propensity score matching, and the groups were compared using multivariable logistic regression models to analyze the effects of various factors on CAUTI development., Results: In the multivariate logistic regression models, abnormal urogenital images (OR 5.30 [95 % CI, 2.40-11.7] and OR 3.44 [95 % CI, 1.16-9.93]) and duration of catheterization >10 days (OR 2.76 [95 % CI, 1.28-5.96] and OR 3.44 [95 % CI, 1.16-9.93]) were found to be significantly associated with development of CAUTI, both before (39 cases, 459 controls) and after propensity score matching (36 cases, 72 controls). Further, CAUTI in young children in the PICU or HCU was significantly associated with imaging abnormalities of the urinary tract., Conclusions: These results suggest that not only the presence of catheters, but also urinary tract malformations may contribute to the development of CAUTI in young children., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate the effects of early mobilization within 48 h of injury on motor function and walking ability in patients with incomplete cervical spinal cord injury (SCI)., Design: A retrospective observational study., Setting: Intensive care unit or high care unit of a university hospital emergency center., Participants: Of 224 patients with SCI having American Spinal Injury Association impairment scale grades C and D, 158 consecutive patients hospitalized for at least 3 weeks after injury were included., Interventions: Patients were categorized into two groups: an early mobilization group in which patients were mobilized within 48 h of injury and a delayed mobilization group in which they were mobilized after 48 h of injury., Outcome Measures: The upper extremity motor score (UEMS), lower extremity motor score (LEMS), and Walking Index for Spinal Cord Injury II (WISCI II) were compared using propensity score matching analysis., Results: Of the 158 patients who met the eligibility criteria, 32 were matched between the groups. There was a significant difference in the change in LEMS from the initial assessment to the assessment 2 weeks postoperatively in the early mobilization group (median 9 points vs. 3 points, p  < 0.05). There were no significant differences in UEMS or WISCI II., Conclusion: Early mobilization within 48 h may improve lower extremity motor function in patients with acute incomplete cervical SCI.

Objective: In this study, we aimed to determine the effects of 2-week neuromuscular electrical stimulation (NMES) on quadriceps muscle atrophy and lower extremity motor score in individuals with subacute incomplete cervical spinal cord injury (SCI)., Methods: This stratified randomized controlled trial, conducted in the advanced critical care center of a university hospital, comprised 49 individuals with American Spinal Injury Association (ASIA) impairment scale grade C and D incomplete cervical SCI. The participants were stratified based on the ASIA impairment scale grade and randomly assigned to the control (n = 25) or NMES (n = 24) group. The control group participants received only conventional rehabilitation; the NMES group participants received conventional rehabilitation plus NMES in the quadriceps muscles of both lower limbs. The primary endpoints were quadriceps muscle thickness and L3 ASIA lower extremity motor score (L3 motor score), measured at the study's initiation and after 2 weeks., Results: The quadriceps muscle thickness changes on the stronger and weaker sides were -14.2% ± 11.3% and -15.1% ± 13.8%, respectively, in the NMES group and -25.7% ± 16.8% and -26.0% ± 13.3%, respectively, in the control group, indicating significantly lesser reduction on both sides in the NMES group ( p <0.05). The L3 motor scores on the stronger and weaker sides were 0.8 ± 1.2 and 1.3 ± 1.4 (NMES group) and 0.4 ± 0.8 and 0.4 ± 0.8 (control group), respectively, indicating significant improvement only on the weaker side ( p <0.05)., Conclusions: For subacute incomplete cervical SCI, 2 weeks of NMES reduces quadriceps muscle atrophy and improves the L3 motor score values on the weaker side compared with standard treatment., Competing Interests: The authors declare that there is no conflicts of interest., (©2024 Japanese Society of Physical Therapy.)

Background/objective: To test the feasibility of a dry eye disease (DED) symptom stratification algorithm previously established for the general population among patients visiting ophthalmologists., Subject/methods: This retrospective cross-sectional study was conducted between December 2015 and October 2021 at a university hospital in Japan; participants who underwent a comprehensive DED examination and completed the Japanese version of the Ocular Surface Disease Index (J-OSDI) were included. Patients diagnosed with DED were stratified into seven clusters using a previously established symptom-based stratification algorithm for DED. Characteristics of the patients in stratified clusters were compared., Results: In total, 426 participants were included (median age [interquartile range]; 63 [48-72] years; 357 (83.8%) women). Among them, 291 (68.3%) participants were diagnosed with DED and successfully stratified into seven clusters. The J-OSDI total score was highest in cluster 1 (61.4 [52.2-75.0]), followed by cluster 5 (44.1 [38.8-47.9]). The tear film breakup time was the shortest in cluster 1 (1.5 [1.1-2.1]), followed by cluster 3 (1.6 [1.0-2.5]). The J-OSDI total scores from the stratified clusters in this study and those from the clusters identified in the previous study showed a significant correlation (r = 0.991, P < 0.001)., Conclusions: The patients with DED who visited ophthalmologists were successfully stratified by the previously established algorithm for the general population, uncovering patterns for their seemingly heterogeneous and variable clinical characteristics of DED. The results have important implications for promoting treatment interventions tailored to individual patients and implementing smartphone-based clinical data collection in the future., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

The coronavirus disease (COVID-19) pandemic has emphasized the paucity of non-contact and non-invasive methods for the objective evaluation of dry eye disease (DED). However, robust evidence to support the implementation of mHealth- and app-based biometrics for clinical use is lacking. This study aimed to evaluate the reliability and validity of app-based maximum blink interval (MBI) measurements using DryEyeRhythm and equivalent traditional techniques in providing an accessible and convenient diagnosis. In this single-center, prospective, cross-sectional, observational study, 83 participants, including 57 with DED, had measurements recorded including slit-lamp-based, app-based, and visually confirmed MBI. Internal consistency and reliability were assessed using Cronbach's alpha and intraclass correlation coefficients. Discriminant and concurrent validity were assessed by comparing the MBIs from the DED and non-DED groups and Pearson's tests for each platform pair. Bland-Altman analysis was performed to assess the agreement between platforms. App-based MBI showed good Cronbach's alpha coefficient, intraclass correlation coefficient, and Pearson correlation coefficient values, compared with visually confirmed MBI. The DED group had significantly shorter app-based MBIs, compared with the non-DED group. Bland-Altman analysis revealed minimal biases between the app-based and visually confirmed MBIs. Our findings indicate that DryEyeRhythm is a reliable and valid tool that can be used for non-invasive and non-contact collection of MBI measurements, which can assist in accessible DED detection and management., (© 2023. Springer Nature Limited.)

Background: Using traditional patient-reported outcomes (PROs), such as paper-based questionnaires, is cumbersome in the era of web-based medical consultation and telemedicine. Electronic PROs may reduce the burden on patients if implemented widely. Considering promising reports of DryEyeRhythm, our in-house mHealth smartphone app for investigating dry eye disease (DED) and the electronic and paper-based Ocular Surface Disease Index (OSDI) should be evaluated and compared to determine their equivalency., Objective: The purpose of this study is to assess the equivalence between smartphone app-based and paper-based questionnaires for DED., Methods: This prospective, nonblinded, randomized crossover study enrolled 34 participants between April 2022 and June 2022 at a university hospital in Japan. The participants were allocated randomly into 2 groups in a 1:1 ratio. The paper-app group initially responded to the paper-based Japanese version of the OSDI (J-OSDI), followed by the app-based J-OSDI. The app-paper group responded to similar questionnaires but in reverse order. We performed an equivalence test based on minimal clinically important differences to assess the equivalence of the J-OSDI total scores between the 2 platforms (paper-based vs app-based). A 95% CI of the mean difference between the J-OSDI total scores within the ±7.0 range between the 2 platforms indicated equivalence. The internal consistency and agreement of the app-based J-OSDI were assessed with Cronbach α coefficients and intraclass correlation coefficient values., Results: A total of 33 participants were included in this study. The total scores for the app- and paper-based J-OSDI indicated satisfactory equivalence per our study definition (mean difference 1.8, 95% CI -1.4 to 5.0). Moreover, the app-based J-OSDI total score demonstrated good internal consistency and agreement (Cronbach α=.958; intraclass correlation=0.919; 95% CI 0.842 to 0.959) and was significantly correlated with its paper-based counterpart (Pearson correlation=0.932, P<.001)., Conclusions: This study demonstrated the equivalence of PROs between the app- and paper-based J-OSDI. Implementing the app-based J-OSDI in various scenarios, including telehealth, may have implications for the early diagnosis of DED and longitudinal monitoring of PROs., (©Ken Nagino, Yuichi Okumura, Yasutsugu Akasaki, Kenta Fujio, Tianxiang Huang, Jaemyoung Sung, Akie Midorikawa-Inomata, Keiichi Fujimoto, Atsuko Eguchi, Shokirova Hurramhon, Alan Yee, Maria Miura, Mizu Ohno, Kunihiko Hirosawa, Yuki Morooka, Akira Murakami, Hiroyuki Kobayashi, Takenori Inomata. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 03.08.2023.)