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According to some Japanese psychiatrists, hikikomori can be caused by panic associated agoraphobia, or by withdrawal due to social anxiety

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However, if middle ear fluid develops due to infection, congestion may linger after the active infection, until the fluid clears

In July the program transferred $57.4 million in state funds, about 5 percent less than last year, to 309 cities, boroughs and unincorporated communities from Anchorage to Yakutat, said Danielle Lindoff, local government specialist with the state Department of Commerce, Community and Economic Development

doi: 10.21037/tlcr.2019.10.22 28 RoskoskiRJr