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Acknowledgements
This report presents the results of the research conducted at the Amagasaki City Institute for Learning and
Growing. We would like to thank the Child and Youth Affairs Bureau, Health and Welfare Bureau, and Borad
of Education of Amagasaki City for providing data and advice. We would also like to thank the Clinical and
Translational Research Center at Kobe University Hospital for aiding with the statistical analysis of the data. We
would like to thank Editage (www.editage.com) for English language editing.
Author contributions
M.N. designed the project and prepared the first draft of the manuscript. K.N. and H.N. designed and supervised
the project and critically reviewed and revised the manuscript for important intellectual content. H.Y., S.O., S.T.,
and K.T. revised the manuscript for important intellectual content. Y.K. and A.K. contributed to data analysis
and interpretation. All authors read and approved the final version of this manuscript for publication.
Funding
This work was partly supported by Grants-in-Aid of the Japan Foundation for Pediatric Research (Grant No.
21-009).
Competing interests The authors declare no competing interests relevant to this study. Outside the submitted work, KN is a member
of advisory groups for Kyowa Kirin Co. Ltd., Toa Eiyo Ltd., and Taisho Pharmaceutical Co. Ltd. KN receives
speakers bureaus from Sumitomo Pharma Co., Ltd., Chugai Pharmaceutical Co. Ltd., and Kyowa Kirin Co., Ltd.
The sponsors had no role in the study design, collection, analysis or interpretation of the data, writing of the
report, or in the decision to submit the manuscript for publication.
Additional information
Supplementary Information The online version contains supplementary material available at https://doi.org/
10.1038/s41598-023-48280-5.
Correspondence and requests for materials should be addressed to M.N.
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