{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:09:23Z","timestamp":1789038563500,"version":"build-2803163510"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T00:00:00Z","timestamp":1640044800000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012781","name":"msd k.k.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012781","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Environ Health Prev Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The best approach to reduce congenital cytomegalovirus infection (cCMVi) is to practice behaviors that reduce cytomegalovirus (CMV) transmission during pregnancy. Expanding awareness and knowledge of CMV is expected to result in increased practice of preventative behaviors. To this end, it is necessary to understand current awareness and knowledge of CMV.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This web-based cross-sectional survey assessed the awareness and knowledge of cCMVi among pregnant women and the general public in Japan. Participants aged 20\u201345\u2009years (pregnant and non-pregnant women, and men) were identified from a consumer panel. Study outcomes (all participants) included awareness of cCMVi and other congenital conditions. Among those aware of cCMVi, outcomes included knowledge of CMV transmission routes, long-term outcomes of cCMVi, and behaviors to prevent CMV transmission during pregnancy. Outcomes limited to pregnant women included the practice of preventative behaviors and opinion on how easy it is to implement these behaviors. The data of the pregnant group (pregnant at the time of the survey) were compared with those of the general group (non-pregnant women and men).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 535 participants in the pregnant group and 571 in the general group. Awareness of cCMVi was generally low (pregnant, 16.1%; general, 10.2%). Pregnant participants were significantly more aware of most congenital conditions than those in the general group, including cCMVi (<jats:italic>P<\/jats:italic>\u2009=\u20090.004). Knowledge about CMV\/cCMVi was limited; there were no significant differences between the two groups for 24 of the 26 knowledge questions. A small proportion (one third or less) of pregnant women practiced behaviors to prevent the transmission of CMV, though most (73.3\u201395.3%) pregnant women who were aware of cCMVi considered such behaviors easy to implement.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Awareness and knowledge of CMV\/cCMVi is low among pregnant women in Japan; the level of knowledge is similar to that among the general public. This needs to be improved. Most pregnant women considered behaviors to prevent CMV transmission easy to perform, which indicates that effectively educating pregnant women regarding the long-term outcomes of cCMVi, CMV transmission routes, and preventative behaviors will contribute to a reduced incidence of cCMVi.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>UMIN Clinical Trials Registry, <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/upload.umin.ac.jp\/cgi-open-bin\/icdr_e\/ctr_view.cgi?recptno=R000046787\">UMIN000041260<\/jats:ext-link>.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12199-021-01029-w","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T15:09:56Z","timestamp":1640099396000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Awareness and knowledge of congenital cytomegalovirus infection among pregnant women and the general public: a web-based survey in Japan"],"prefix":"10.1186","volume":"26","author":[{"given":"Masayuki","family":"Kobayashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aya","family":"Okahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotoba","family":"Okuyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Hiraishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Morioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"issue":"4","key":"1029_CR1","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1002\/rmv.535","volume":"17","author":"A Kenneson","year":"2007","unstructured":"Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol. 2007;17(4):253\u201376. https:\/\/doi.org\/10.1002\/rmv.535.","journal-title":"Rev Med Virol"},{"issue":"1","key":"1029_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2011-000118","volume":"1","author":"S Koyano","year":"2011","unstructured":"Koyano S, Inoue N, Oka A, Moriuchi H, Asano K, Ito Y, et al. Screening for congenital cytomegalovirus infection using newborn urine samples collected on filter paper: feasibility and outcomes from a multicentre study. BMJ Open. 2011;1(1):e000118. https:\/\/doi.org\/10.1136\/bmjopen-2011-000118.","journal-title":"BMJ Open"},{"issue":"1","key":"1029_CR3","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013810","volume":"7","author":"A Yamaguchi","year":"2017","unstructured":"Yamaguchi A, Oh-Ishi T, Arai T, Sakata H, Adachi N, Asanuma S, et al. Screening for seemingly healthy newborns with congenital cytomegalovirus infection by quantitative real-time polymerase chain reaction using newborn urine: an observational study. BMJ Open. 2017;7(1):e013810. https:\/\/doi.org\/10.1136\/bmjopen-2016-013810.","journal-title":"BMJ Open"},{"issue":"8","key":"1029_CR4","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1080\/00016489.2018.1441545","volume":"138","author":"H Moteki","year":"2018","unstructured":"Moteki H, Isaka Y, Inaba Y, Motobayashi M, Nishio SY, Ohira S, et al. A rational approach to identifying newborns with hearing loss caused by congenital cytomegalovirus infection by dried blood spot screening. Acta Otolaryngol. 2018;138(8):708\u201312. https:\/\/doi.org\/10.1080\/00016489.2018.1441545.","journal-title":"Acta Otolaryngol"},{"issue":"2","key":"1029_CR5","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.braindev.2015.08.003","volume":"38","author":"K Nishida","year":"2016","unstructured":"Nishida K, Morioka I, Nakamachi Y, Kobayashi Y, Imanishi T, Kawano S, et al. Neurological outcomes in symptomatic congenital cytomegalovirus-infected infants after introduction of newborn urine screening and antiviral treatment. Brain and Development. 2016;38(2):209\u201316. https:\/\/doi.org\/10.1016\/j.braindev.2015.08.003.","journal-title":"Brain and Development"},{"issue":"5","key":"1029_CR6","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1002\/rmv.544","volume":"17","author":"SC Dollard","year":"2007","unstructured":"Dollard SC, Grosse SD, Ross DS. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Rev Med Virol. 2007;17(5):355\u201363. https:\/\/doi.org\/10.1002\/rmv.544.","journal-title":"Rev Med Virol"},{"issue":"9","key":"1029_CR7","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.1093\/cid\/cit018","volume":"56","author":"CL Townsend","year":"2013","unstructured":"Townsend CL, Forsgren M, Ahlfors K, Ivarsson SA, Tookey PA, Peckham CS. Long-term outcomes of congenital cytomegalovirus infection in Sweden and the United Kingdom. Clin Infect Dis. 2013;56(9):1232\u20139. https:\/\/doi.org\/10.1093\/cid\/cit018.","journal-title":"Clin Infect Dis"},{"issue":"Suppl 4","key":"1029_CR8","doi-asserted-by":"publisher","first-page":"S178","DOI":"10.1093\/cid\/cit629","volume":"57","author":"SB Boppana","year":"2013","unstructured":"Boppana SB, Ross SA, Fowler KB. Congenital cytomegalovirus infection: clinical outcome. Clin Infect Dis. 2013;57(Suppl 4):S178\u201381. https:\/\/doi.org\/10.1093\/cid\/cit629.","journal-title":"Clin Infect Dis"},{"issue":"5","key":"1029_CR9","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1002\/rmv.1790","volume":"24","author":"MJ Cannon","year":"2014","unstructured":"Cannon MJ, Griffiths PD, Aston V, Rawlinson WD. Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit? Rev Med Virol. 2014;24(5):291\u2013307. https:\/\/doi.org\/10.1002\/rmv.1790.","journal-title":"Rev Med Virol"},{"issue":"5","key":"1029_CR10","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.ejpn.2014.04.007","volume":"18","author":"I Dakovic","year":"2014","unstructured":"Dakovic I, da Graca AM, Folha T, Neubauer D, Hollody K, Honold M, et al. Clinical features of cerebral palsy in children with symptomatic congenital cytomegalovirus infection. Eur J Paediatr Neurol. 2014;18(5):618\u201323. https:\/\/doi.org\/10.1016\/j.ejpn.2014.04.007.","journal-title":"Eur J Paediatr Neurol"},{"issue":"3","key":"1029_CR11","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1016\/j.jpeds.2013.03.014","volume":"163","author":"A Alarcon","year":"2013","unstructured":"Alarcon A, Martinez-Biarge M, Cabanas F, Hernanz A, Quero J, Garcia-Alix A. Clinical, biochemical, and neuroimaging findings predict long-term neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr. 2013;163(3):828\u201334.e1. https:\/\/doi.org\/10.1016\/j.jpeds.2013.03.014.","journal-title":"J Pediatr"},{"issue":"5","key":"1029_CR12","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1542\/peds.2014-1173","volume":"134","author":"J Goderis","year":"2014","unstructured":"Goderis J, De Leenheer E, Smets K, Van Hoecke H, Keymeulen A, Dhooge I. Hearing loss and congenital CMV infection: a systematic review. Pediatrics. 2014;134(5):972\u201382. https:\/\/doi.org\/10.1542\/peds.2014-1173.","journal-title":"Pediatrics."},{"issue":"1","key":"1029_CR13","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.jpeds.2007.12.049","volume":"153","author":"I Foulon","year":"2008","unstructured":"Foulon I, Naessens A, Foulon W, Casteels A, Gordts F. A 10-year prospective study of sensorineural hearing loss in children with congenital cytomegalovirus infection. J Pediatr. 2008;153(1):84\u20138. https:\/\/doi.org\/10.1016\/j.jpeds.2007.12.049.","journal-title":"J Pediatr"},{"key":"1029_CR14","unstructured":"World Health Organization. Global vaccine action plan 2011\u20132020. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/78141\/9789241504980_eng.pdf. Accessed 28 Sep 2021."},{"key":"1029_CR15","unstructured":"Centers for Disease Control and Prevention. About cytomegalovirus (CMV). 2020. https:\/\/www.cdc.gov\/cmv\/overview.html. Accessed 22 Feb 2021."},{"key":"1029_CR16","doi-asserted-by":"publisher","unstructured":"Morioka I, Sonoyama A, Tairaku S, Ebina Y, Nagamata S, Morizane M, et al. Awareness of and knowledge about mother-tochild infections in Japanese pregnant women. Congenit Anom (Kyoto). 2014;54:35\u201340. https:\/\/doi.org\/10.1111\/cga.12030.","DOI":"10.1111\/cga.12030"},{"key":"1029_CR17","doi-asserted-by":"publisher","unstructured":"Cordier AG, Guitton S, Vauloup-Fellous C, Grangeot-Keros L, Ayoubi JM, Benachi A, et al. Awareness of cytomegalovirus infection among pregnant women in France. J Clin Virol. 2012;53(1):332\u20137. https:\/\/doi.org\/10.1016\/j.jcv.2011.12.031.","DOI":"10.1016\/j.jcv.2011.12.031"},{"issue":"4","key":"1029_CR18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0244945","volume":"16","author":"S Suga","year":"2021","unstructured":"Suga S, Fujioka K, Nakasone R, Abe S, Fukushima S, Ashina M, et al. Changes in awareness and knowledge concerning mother-to-child infections among Japanese pregnant women between 2012 and 2018. PLoS One. 2021;16(4):e0244945. https:\/\/doi.org\/10.1371\/journal.pone.0244945.","journal-title":"PLoS One"},{"issue":"1","key":"1029_CR19","doi-asserted-by":"publisher","first-page":"80383","DOI":"10.1155\/IDOG\/2006\/80383","volume":"2006","author":"J Jeon","year":"2006","unstructured":"Jeon J, Victor M, Adler SP, Arwady A, Demmler G, Fowler K, et al. Knowledge and awareness of congenital cytomegalovirus among women. Infect Dis Obstet Gynecol. 2006;2006(1):80383. https:\/\/doi.org\/10.1155\/IDOG\/2006\/80383.","journal-title":"Infect Dis Obstet Gynecol"},{"issue":"1","key":"1029_CR20","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1186\/s12879-016-1861-z","volume":"16","author":"S Binda","year":"2016","unstructured":"Binda S, Pellegrinelli L, Terraneo M, Caserini A, Primache V, Bubba L, et al. What people know about congenital CMV: an analysis of a large heterogeneous population through a web-based survey. BMC Infect Dis. 2016;16(1):513. https:\/\/doi.org\/10.1186\/s12879-016-1861-z.","journal-title":"BMC Infect Dis"},{"issue":"8","key":"1029_CR21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221725","volume":"14","author":"KJ Tastad","year":"2019","unstructured":"Tastad KJ, Schleiss MR, Lammert SM, Basta NE. Awareness of congenital cytomegalovirus and acceptance of maternal and newborn screening. PLoS One. 2019;14(8):e0221725. https:\/\/doi.org\/10.1371\/journal.pone.0221725.","journal-title":"PLoS One"},{"key":"1029_CR22","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/1471-2393-13-98","volume":"13","author":"MT Pereboom","year":"2013","unstructured":"Pereboom MT, Mannien J, Spelten ER, Schellevis FG, Hutton EK. Observational study to assess pregnant women's knowledge and behaviour to prevent toxoplasmosis, listeriosis and cytomegalovirus. BMC Pregnancy Childbirth. 2013;13:98. https:\/\/doi.org\/10.1186\/1471-2393-13-98.","journal-title":"BMC Pregnancy Childbirth"},{"issue":"3","key":"1029_CR23","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1515\/jpm-2020-0301","volume":"49","author":"F Vena","year":"2020","unstructured":"Vena F, D'Ambrosio V, Pajno C, Boccherini C, Corno S, Di Mascio D, et al. Pregnant women's knowledge and behaviour to prevent cytomegalovirus infection: an observational study. J Perinat Med. 2020;49(3):327\u201332. https:\/\/doi.org\/10.1515\/jpm-2020-0301.","journal-title":"J Perinat Med"},{"issue":"2","key":"1029_CR24","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jcv.2012.06.022","volume":"55","author":"AG Cordier","year":"2012","unstructured":"Cordier AG, Guitton S, Vauloup-Fellous C, Grangeot-Keros L, Benachi A, Picone O. Awareness and knowledge of congenital cytomegalovirus infection among health care providers in France. J Clin Virol. 2012;55(2):158\u201363. https:\/\/doi.org\/10.1016\/j.jcv.2012.06.022.","journal-title":"J Clin Virol"},{"issue":"Suppl 4","key":"1029_CR25","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1016\/j.jcv.2009.09.006","volume":"46","author":"AM Korver","year":"2009","unstructured":"Korver AM, de Vries JJ, de Jong JW, Dekker FW, Vossen AC, Oudesluys-Murphy AM. Awareness of congenital cytomegalovirus among doctors in the Netherlands. J Clin Virol. 2009;46(Suppl 4):S11\u20135. https:\/\/doi.org\/10.1016\/j.jcv.2009.09.006.","journal-title":"J Clin Virol"},{"issue":"1","key":"1029_CR26","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s13052-018-0470-4","volume":"44","author":"A Hosseinzadeh Adli","year":"2018","unstructured":"Hosseinzadeh Adli A, Karami C, Baghban Rahimi S, Mirarab A, Tabarraei A. What family doctors know about congenital CMV: a regional survey in Iran. Ital J Pediatr. 2018;44(1):31. https:\/\/doi.org\/10.1186\/s13052-018-0470-4.","journal-title":"Ital J Pediatr"},{"issue":"3","key":"1029_CR27","first-page":"65","volume":"57","author":"Centers for Disease Control and Prevention","year":"2008","unstructured":"Centers for Disease Control and Prevention. Knowledge and practices of obstetricians and gynecologists regarding cytomegalovirus infection during pregnancy--United States, 2007. MMWR Morb Mortal Wkly Rep. 2008;57(3):65\u20138.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"1029_CR28","doi-asserted-by":"publisher","unstructured":"Fowler KB, Davies SL, Kempf MC, Boppana S, Cannon MJ, Tita A, et al. Increasing awareness and promoting strategies for prevention of congenital cytomegalovirus infection among young pregnant women. Am J Obstet Gynecol. 2017;217(6):734. https:\/\/doi.org\/10.1016\/j.ajog.2017.08.022.","DOI":"10.1016\/j.ajog.2017.08.022"},{"key":"1029_CR29","unstructured":"Ministry of Health, Labour and Welfare, Japan. Live birth by age of mother, vital statistics in Japan. 2018. https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/jinkou\/geppo\/nengai18\/dl\/h3-4.pdf. Accessed 22 Feb 2021. (Japanese)."},{"key":"1029_CR30","doi-asserted-by":"publisher","unstructured":"Public Policy Committee ISoP. Guidelines for good pharmacoepidemiology practice (GPP). Pharmacoepidemiol Drug Saf 2016;25(1):2\u201310. https:\/\/doi.org\/10.1002\/pds.3891.","DOI":"10.1002\/pds.3891"},{"key":"1029_CR31","unstructured":"Ministry of Education, Culture, Sports, Science and Technology, Ministry of Health, Labour and Welfare, Japan. Ethical Guidelines for Medical and Health Research Involving Human Subjects. 2017. https:\/\/www.mhlw.go.jp\/file\/06-Seisakujouhou-10600000-Daijinkanboukouseikagakuka\/0000153339.pdf. Accessed 22 Feb 2021. (Japanese)."},{"key":"1029_CR32","doi-asserted-by":"publisher","unstructured":"Adler SP, Finney JW, Manganello AM, Best AM. Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial. Pediatr Infect Dis J. 1996;15(3):240\u20136. https:\/\/doi.org\/10.1097\/00006454-199603000-00013.","DOI":"10.1097\/00006454-199603000-00013"},{"key":"1029_CR33","doi-asserted-by":"publisher","unstructured":"Okahashi A, Kobayashi M, Okuyama K, Hiraishi N, Morioka I. Survey of physician knowledge of congenital cytomegalovirus infection and clinical practices in Japan A web-based survey. Medicine. 2021;100(44):e27589. https:\/\/doi.org\/10.1097\/MD.0000000000027589.\u00a0","DOI":"10.1097\/MD.0000000000027589"}],"container-title":["Environmental Health and Preventive Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12199-021-01029-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12199-021-01029-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12199-021-01029-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T15:09:59Z","timestamp":1640099399000},"score":1,"resource":{"primary":{"URL":"https:\/\/environhealthprevmed.biomedcentral.com\/articles\/10.1186\/s12199-021-01029-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1029"],"URL":"https:\/\/doi.org\/10.1186\/s12199-021-01029-w","relation":{},"ISSN":["1342-078X","1347-4715"],"issn-type":[{"value":"1342-078X","type":"print"},{"value":"1347-4715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"29 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the ethics review board of the Medical Corporation Toukeikai Kitamachi Clinic, and all participants provided electronic informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MK, KO, and NH are employees of MSD K.K., Tokyo, Japan, a subsidiary of Merck & Co., Inc., Kenilworth, N.J., USA., and may own stock and\/or hold stock options in Merck & Co., Inc., Kenilworth, N.J., USA. AO has received personal fees from AbbVie, LLC outside of the submitted work.\u00a0IM has received grants from Japan Blood Product\u00a0Organization, Eli Lilly Japan K.K., AbbVie LLC, Teijin Pharma Co., Ltd., Chugai Pharmaceutical Co., Ltd., Shionogi Co., Ltd.,\u00a0and JCR Pharmaceuticals Co., Ltd.; lecture fees from MSD Co., Ltd., Pfizer Japan, Inc., Novo Nordisk Pharma Ltd., Shionogi Co.,\u00a0Ltd., AbbVie LLC, Shino-test Corp., and Atom Medical Corp outside of the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"117"}}