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Article History

Received: 26 April 2025

Accepted: 28 August 2025

First Online: 30 September 2025

Declarations

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: According to the Ethical Review Board of Kochi Medical School, survey-based studies such as the present study do not require formal ethical review. Consequently, this study was conducted in compliance with the regulations of the authors’ affiliated university (Kochi University) and the local government of the research site (Tosa Town Well-being Survey Review Committee). This study adhered to the ethical principles of the Declaration of Helsinki (2013), an international guideline that emphasizes the protection of the dignity, rights, safety, and well-being of human participants. In accordance with these principles, we also followed the relevant research ethics guidelines issued by the Japanese government and our affiliated institution. Specifically, the research ethics guidelines of Kochi University are based on the “Ethical Guidelines for Life Science and Medical Research Involving Human Subjects,” jointly issued by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), the Ministry of Health, Labour and Welfare (MHLW), and the Ministry of Economy, Trade and Industry (METI) of Japan, and implemented on June 30, 2021. With regard to informed consent in this study, all participants received a written explanation of the study’s purpose and procedures prior to their participation. They were clearly informed that their participation was entirely voluntary and that they could withdraw at any time without any consequences. Written informed consent was obtained only from those who confirmed their understanding and agreed to participate.

: Not applicable.

: The authors declare no competing interests.