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News Article | May 4, 2017
Site: www.prnewswire.co.uk

Network meta-analysis is becoming increasingly important for decision makers to assess the comparative efficacy and safety of interventions and is integral to health technology assessment (HTA). The exploration of covariate effects is important in NMA because the presence of unaccounted treatment covariate interactions can invalidate the assumptions that underlie NMA and bias results. Visually assimilating, exploring and interpreting the distribution of covariate values across trials in an NMA is challenging due to the complexities of representing the network structure alongside study-level covariate values. In a recently published paper in the Journal of Clinical Epidemiology, DRG Abacus and Leicester University outline the rationale for and the features of the software tool and present a series of illustrative examples. For more information contact our Systematic Review team at Access@TeamDRG.com Follow DRG on Twitter @DRGInsights and on LinkedIn and keep up with the latest industry news on the DRG Blog. About Decision Resources Group DRG, a subsidiary of Piramal Enterprises Ltd., offers best-in-class, high-value data, analytics and insights products and services to the healthcare industry, delivered by more than 1000 employees across 17 offices in North America, Europe and Asia. DRG provides the Life Sciences, Provider, Payer and Financial Services industries the data, tools, insights and advice they need to compete and thrive in an increasingly complex and value-based marketplace. decisionresourcesgroup.com.


Grimshaw J.M.,Clinical Epidemiology
Implementation Science | Year: 2011

Background: Guidelines continue to be underutilized, and a variety of strategies to improve their use have been suboptimal. Modifying guideline features represents an alternative, but untested way to promote their use. The purpose of this study was to identify and define features that facilitate guideline use, and examine whether and how they are included in current guidelines.Methods: A guideline implementability framework was developed by reviewing the implementation science literature. We then examined whether guidelines included these, or additional implementability elements. Data were extracted from publicly available high quality guidelines reflecting primary and institutional care, reviewed independently by two individuals, who through discussion resolved conflicts, then by the research team.Results: The final implementability framework included 22 elements organized in the domains of adaptability, usability, validity, applicability, communicability, accommodation, implementation, and evaluation. Data were extracted from 20 guidelines on the management of diabetes, hypertension, leg ulcer, and heart failure. Most contained a large volume of graded, narrative evidence, and tables featuring complementary clinical information. Few contained additional features that could improve guideline use. These included alternate versions for different users and purposes, summaries of evidence and recommendations, information to facilitate interaction with and involvement of patients, details of resource implications, and instructions on how to locally promote and monitor guideline use. There were no consistent trends by guideline topic.Conclusions: Numerous opportunities were identified by which guidelines could be modified to support various types of decision making by different users. New governance structures may be required to accommodate development of guidelines with these features. Further research is needed to validate the proposed framework of guideline implementability, develop methods for preparing this information, and evaluate how inclusion of this information influences guideline use. © 2011 Gagliardi et al; licensee BioMed Central Ltd.


News Article | February 15, 2017
Site: www.eurekalert.org

OTTAWA, ON - Wednesday, February 15, 2017, 10 a.m. ET - BioCanRx, and its partners, today announced funding for 16 collaborative research projects in novel therapies to cure cancer including research aimed at developing clinical Chimeric Antigen Receptor modified T cell (CAR-T) manufacturing capabilities in Canada. CAR-Ts are a powerful new tool for treating cancer and have begun to provide hope to patients without other therapeutic options to treat and cure their disease. CAR-T cell therapy is on the cutting edge of cancer therapeutics and has shown promise in paediatric and adult patients with certain blood cancers such as acute lymphoblastic leukemia and lymphoma. CAR-T is a promising technology, involving sophisticated manufacturing and expertise. Canada has the basic laboratory infrastructure in place and this new funding will help to fully develop the expertise and capacity required to deliver this technology. BioCanRx is investing in research projects advancing several innovative engineered T cell designs, which will further benefit from this infrastructure and capacity investment, and accelerate delivery of these novel concepts into clinical testing in Canada. This Canadian capacity development will pave the way to enable Canadian patients to access this new technology, and will give Canadian researchers the necessary resources to deliver on their innovations in CAR-T and other engineered T cell platforms. This CAR-T manufacturing initiative is unique in that the Canadian academic community recognized a gap and stepped up to drive Canadian solutions to meet grassroots efforts taking place in the U.S., China and Europe. BioCanRx has established an extensive network of investigators and core facilities across the country and is well positioned to bring CAR-T cell treatment to patients in Canada who are in dire need. Leading this capacity building for CAR-T therapies in Canada are Dr. Robert Holt, distinguished scientist, BC Cancer Agency, Head of Sequencing and Head of Quality Systems, Canada's Michael Smith Genome Sciences Centre, Professor, Medical Genetics, University of British Columbia and Professor, Molecular Biology and Biochemistry, Simon Fraser University; Dr. John Bell, Sr. Scientist, Centre for Innovative Cancer Research, Ottawa Hospital Research Institute, Professor, Departments of Medicine and Biochemistry, Microbiology & Immunology, University of Ottawa and Scientific Director, BioCanRx; John Webb, Scientist and Project Leader, BC Cancer Agency Deeley Research Centre and Adjunct Associate Professor, University of Victoria; Brad Nelson, Director, Deeley Research Centre, BC Cancer Agency among other researchers. To help ensure CAR-T cell therapy is brought to patients safely and effectively, BioCanRx is funding a companion Clinical, Social, and Economic Impact project. It will review the existing base of knowledge and involve patient consultation to design a rigorous CAR-T clinical trial protocol ready to implement once the products are ready for a phase 1 clinical trial. Leading this project are Dr. Manoj Lalu, Associate Scientist, Assistant Professor, Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute (OHRI), Department of Anesthesiology and Pain Medicine, University of Ottawa; Dr. Dean Fergusson, Director and Senior Scientist, Clinical Epidemiology Program, OHRI; Dr. Natasha Kekre, Assistant Professor, Associate Scientist, Hematologist, Blood and Marrow Transplant Program, OHRI, The Ottawa Hospital, University of Ottawa among other researchers. Cancer is the leading cause of death in Canada and is responsible for 30% of all deaths. Two out of five Canadians (45% of men and 42% of women) are expected to develop cancer during their lifetimes. One out of four Canadians (29% of men and 24% of women) is expected to die from cancer. (Canadian Cancer Society) Biotherapeutics - including oncolytic viruses, adoptive cell therapy and therapeutic antibodies - are among the most promising cancer therapies to emerge in the last decade and are often referred to as a fourth pillar for cancer treatment. BioCanRx is building a research portfolio of these immunotherapies but what sets it apart is its commitment to combination therapies. Combining biotherapeutics approaches can amplify effectiveness and result in significantly better outcomes compared to the benefits of an individual biotherapy used on its own. Today's funding announcement will support 16 national research teams comprised of researchers, clinicians and trainees working to find improved treatment options and outcomes for cancer patients. BioCanRx's funded partnerships will strengthen the coordination of research and resources in Canada to further develop a variety of cancer immunotherapy platforms. The research proposed could lead to significantly better outcomes for cancer patients and, potentially, curative approaches to their cancer. "CAR-T technology is a new and exciting development that's really taken the world by storm. We know now that by taking T cells out of patients, and reengineering them as it were in a test tube, we can get them to have dramatic responses in some kinds of cancer patients. Unfortunately, in Canada, we don't have this technology available to us to be used widely across the country. So this funding will allow us to be in a position to manufacture this kind of product ourselves, get our own scientists engaged in being able to actually test their ideas, exploiting this new technology and, we hope, to bring something to the Canadian people much faster than it would be otherwise." "BioCanRx is committed to investing in collaborative research projects aimed at improving the health and lives of thousands of Canadians currently living with cancer. Collaboration is critical to ensuring better use of study results and providing a measurable difference. We are confident that this research will address existing gaps in moving this platform forward." "The impact cancer is having on our population is devastating. While we have made enormous progress in treating cancer, much more needs to be understood about better ways to fight this disease and ultimately cure those afflicted. BioCanRx is committed to supporting research excellence and its translation into health benefits for Canadians. We hope to one day announce that there has been a significant reduction in deaths related to cancer thanks to research support by our network and partners. "My congratulations to the sixteen national teams receiving funding through BioCanRx's research program. By advancing the field of immunotherapies, your work will ultimately be able to support innovative and promising new cancer treatments for Canadians." "Canadian scientists are world-renowned for their research into how the body's immune system can be used to treat cancer. This emerging field of medical research has the potential to save lives as well as improve them. It also creates better jobs and opportunities for Canadians working in the life-sciences sector. The funding being allocated to Canadian research teams through BioCanRx will allow this promising research to move beyond laboratories and into clinics, where it can actually make a difference in people's lives. That's how innovation makes a better Canada." The Honourable Navdeep Bains Canada's Minister of Innovation, Science and Economic Development "The use of CAR-T cells represents a significant and very recent advancement in cancer treatment and has become a powerful tool for converting incurable into curable. Unfortunately, the use of this therapy in Canada has been limited by our access to the product, forcing cancer patients to travel far and wide, usually outside Canada, to access this therapy in US clinical trials. A home grown Canadian solution is long overdue - BioCanRx has taken a bold step in ensuring this innovative new therapy is available for Canadians in Canada." Patrick Sullivan Childhood cancer advocate, President, Team Finn Foundation and founding member of Ac2orn (Advocacy for Canadian Oncology Research Network) The BioCanRx network is accelerating to the clinic Canada's most promising and innovative cancer biotherapeutics designed to save lives and enable a better quality of life. BioCanRx invests in Canadian innovations and the best the field has to offer, always looking for a clear path to the clinic for the benefit of patients. BioCanRx works in partnership with industry, charities and other agencies to translate immune-based technologies from the lab into early phase clinical trials, and addresses socio-economic considerations necessary for their adoption by health-care systems. The network is developing and attracting the talent needed for a thriving health biotechnology sector in Canada. BioCanRx is provided funding from the federal government's Networks of Centres of Excellence, and support from industry, the provinces and many national charities.


News Article | October 27, 2016
Site: www.eurekalert.org

Washington, DC -- Individualized supplement doses help protect pregnant women from vitamin D deficiency, according to a new study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism. The research found vitamin D supplements are less effective at raising vitamin D levels in pregnant women if they deliver their babies in the winter, have low levels of vitamin D early in pregnancy or gain more weight during pregnancy. Women with these risk factors may need higher doses during pregnancy than other mothers-to-be. Vitamin D is a hormone that helps the body absorb calcium. It plays a crucial role in bone and muscle health. The skin naturally produces vitamin D after exposure to sunlight. People also obtain smaller amounts of the vitamin through foods, such as milk fortified with vitamin D. Vitamin D deficiency is common, including among pregnant women. Evidence suggests vitamin D deficiency during pregnancy can harm maternal health, fetal development and the child's long-term skeletal health. "It is critical for pregnant women to have sufficient levels of vitamin D for the health of their baby," said one of the study's authors, Nicholas C. Harvey, MA, MB, BChir, MRCP, PhD, Professor of Rheumatology and Clinical Epidemiology at the University of Southampton in Southampton, U.K. "Our study findings suggest that in order to optimize vitamin D concentrations through pregnancy, the supplemental dose given may need to be tailored to a woman's individual circumstances, such as the anticipated season of delivery." The analysis examined data from the Maternal Vitamin D Osteoporosis Study (MAVIDOS), a multi-center, double-blind, randomized, placebo-controlled trial of vitamin D supplementation in pregnancy. The study examined vitamin D levels in 829 pregnant women who received early pregnancy ultrasounds at one of three United Kingdom hospitals. Beginning around 14 weeks' gestation, the women were randomized to receive either a 1000 IU/day dose of a vitamin D3 supplement called cholecalciferol or a placebo. Researchers measured vitamin D levels in the participants' blood prior to the start of the study and again at 34 weeks' gestation. Participants who received the supplement had varying levels of vitamin D in the blood, even though they received the same dose. Researchers found women who delivered in the summer, who gained less weight during pregnancy and who had higher vitamin D levels early in pregnancy tended to have higher levels of vitamin D in the blood than their counterparts. Women who consistently took the supplement also had higher levels of vitamin D than participants who did not. "Our findings of varied responses to vitamin D supplementation according to individual attributes can be used to tailor approaches to prenatal care," said one of the study's authors, Cyrus Cooper, OBE, MA, DM, FRCP, FFPH, FMedSci, Professor of Rheumatology and Clinical Epidemiology at the University of Southampton's MRC Lifecourse Epidemiology Unit. "This work will inform the development of strategies to enhance bone development across generations." The study, "Determinants of the Maternal 25-hydroxyvitamin D Response to Vitamin D Supplementation During Pregnancy," will be published online at http://press. , ahead of print. Other authors of the study include: Rebecca J. Moon, Stefania D'Angelo, Sarah R. Crozier, Hazel M. Inskip, Elaine M. Dennison and Sian M. Robinson of Southampton General Hospital in Southampton, U.K.; Inez Schoenmakers and Ann Prentice of the Elsie Widdowson Laboratory in Cambridge, U.K.; Nigel K. Arden, Andrew Carr and M. Kassim Javaid of the University of Oxford in Oxford, U.K.; Nicholas J. Bishop of Sheffield Children's Hospital and the University of Sheffield in Sheffield, U.K.; Richard Eastell of the University of Sheffield in Sheffield, U.K.; Robert Fraser and Saurabh V. Gandhi of the Sheffield Hospitals NHS Trust in Sheffield, U.K.; Keith M. Godfrey of Southampton General Hospital and the University of Southampton in Southampton, U.K.; Stephen Kennedy and Aris T. Papageorghiou of John Radcliffe Hospital at the University of Oxford in Oxford, U.K.; M. Zulf Mughal of Royal Manchester Children's Hospitals in Manchester, U.K.; and David M. Reid at the University of Aberdeen in Aberdeen, U.K. The research was supported by grants from Arthritis Research UK, Medical Research Council, Bupa Foundation, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford. Merck GmbH provided the vitamin D supplement used in the study. For more information on vitamin D, visit the Hormone Health Network's website. Endocrinologists are at the core of solving the most pressing health problems of our time, from diabetes and obesity to infertility, bone health, and hormone-related cancers. The Endocrine Society is the world's oldest and largest organization of scientists devoted to hormone research and physicians who care for people with hormone-related conditions. The Society, which is celebrating its centennial in 2016, has more than 18,000 members, including scientists, physicians, educators, nurses and students in 122 countries. To learn more about the Society and the field of endocrinology, visit our site at http://www. . Follow us on Twitter at @TheEndoSociety and @EndoMedia.


News Article | November 19, 2016
Site: www.prweb.com

A new report out of Michigan suggests that chemotherapy maximizes the odds of survival for people with malignant pleural mesothelioma. Click here to read the details in a newly published article on the Surviving Mesothelioma website. Scientists with Wayne State University in Detroit analyzed the cases of more than 1,600 mesothelioma patients between January 2005 and December 2009. They used data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database to determine which mesothelioma treatments produced the most promising results. “Irrespective of surgical resection, mesothelioma patients receiving some form of chemotherapy survived longer than patients who did not, with an additional survival benefit among those patients receiving multimodal treatment,” writes Dr. Jennifer Lynn Beebe-Dimmer, lead author on the paper. The report, published in Clinical Epidemiology, found that patients receiving chemotherapy for their mesothelioma lived a median of 7 months. Second-line chemotherapy extended survival for a median of an additional 5 months. “Deciding which types of treatments to pursue is one of the most difficult decisions facing mesothelioma patients and families,” says Alex Strauss, Managing Editor of Surviving Mesothelioma. “Studies like this one provide vital information that can help make those decisions a little easier.” For the full details of the analysis, see Study Finds Chemotherapy Maximizes Odds of Mesothelioma Survival, now available on the Surviving Mesothelioma website. Beebe-DImmer, JL, et al, “Mesothelioma in the United States: a Surveillance, Epidemiology, and End Results (SEER)-Medicare Investigation of treatment patterns and overall survival”, October 26, 2016, Clinical Epidemiology, eCollection, https://www.dovepress.com/mesothelioma-in-the-united-states-a-surveillance-epidemiology-and-end--peer-reviewed-article-CLEP For nearly ten years, Surviving Mesothelioma has brought readers the most important and ground-breaking news on the causes, diagnosis and treatment of mesothelioma. All Surviving Mesothelioma news is gathered and reported directly from the peer-reviewed medical literature. Written for patients and their loved ones, Surviving Mesothelioma news helps families make more informed decisions.


Espinoza S.E.,Gerontology and Palliative Medicine | Espinoza S.E.,University of Texas Health Science Center at San Antonio | Espinoza S.E.,Geriatrics Research | Hazuda H.P.,Clinical Epidemiology | Hazuda H.P.,University of Texas Health Science Center at San Antonio
Journal of the American Geriatrics Society | Year: 2015

OBJECTIVES: To examine the association between neighborhood residence and frailty prevalence in older Mexican Americans (MAs). DESIGN: Cross-sectional, observational study. SETTING: Socioeconomically and ethnically diverse neighborhoods in San Antonio, Texas. PARTICIPANTS: Community-dwelling older MA adults (aged ≥65) who completed the baseline examination of the San Antonio Longitudinal Study of Aging (SALSA) (1992-1996) (N = 394). MEASUREMENTS: Subjects were randomly sampled from three types of neighborhoods that varied in ethnic composition and economic environment: barrio (low-income, exclusively MA), transitional (middle-income, equal proportion MAs and European Americans (EAs)) and suburban (upper-income, predominantly EA). Frailty was classified using the Fried criteria. Frailty odds were estimated according to neighborhood using logistic regression, with the suburban neighborhood as the reference category. Covariates included age, sex, diseases, depressive symptoms, and cognitive function. RESULTS: Frailty prevalence was 15.6% in the barrio, 9.4% in the transitional neighborhood, and 3.5% in the suburbs (P = .01). After adjusting for sociodemographic characteristics and disease covariates, odds of frailty were 4.15 times as high for MAs residing in the barrio as for those residing in the suburbs (P = .03). After adjustment for depression and cognition, this association was no longer significant. Diabetes mellitus and depression accounted for the higher odds of frailty in the barrio. Although odds of frailty in the transitional neighborhood were 1.95 times as high as those in the suburbs, the difference was not statistically significant. CONCLUSION: The ethnic composition and economic environment of the neighborhoods in which MA older adults reside are strongly associated with their odds of being frail. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.


News Article | November 10, 2016
Site: www.eurekalert.org

Hamilton, ON (Nov. 9, 2016) -- Middle-age adults living with a combination of arthritis, heart disease or diabetes, and depression are more likely to experience disability and limited involvement in society, new research from McMaster University has found. The study, published in the Journal of Epidemiology and Community Health, found that physical and mental chronic conditions, alone and in combination, were strongly associated with disability and social participation restrictions. However, the impact of these combinations of conditions differed by gender and age. The research was led by Lauren Griffith, an associate professor in the Department of Clinical Epidemiology and Biostatics and the holder of the McLaughlin Foundation Professorship in Population and Public Health. "These findings help us to better understand, at a population level, the biggest drivers of disability for middle-aged and older adults," said Griffith. "What this research shows is that depending on your age and sex, the specific chronic diseases most highly associated with disability in the population differ." To conduct the study, the research team analyzed population-based data from more than 15,000 participants in the Canadian Community Health Survey on Healthy Aging. The survey, which was conducted between 2008 and 2009, gathered information from adults aged 45 to 85 years old who were not institutionalized and living in one of 10 Canadian provinces. While the association between single chronic conditions and disability is well documented, there is little research examining the combination of both physical and mental chronic conditions on disability and social participation. The researchers concluded that knowing which chronic conditions are associated with greater disability and social participation limitations may help clinicians to target treatment strategies for patients. Similarly, for policy-makers, this information may help in the development of preventative health strategies for individual conditions, as well as clusters of diseases. "Oftentimes, when we are looking at disability, especially for chronic conditions, we are looking at the 65 and older age group," Griffith said. "But if we want to be able to develop interventions earlier to help prevent or slow down the progression of disability, we need to start looking at the impact of chronic conditions on younger age groups." A downloadable photo of Lauren Griffith may be found here: http://adobe. McMaster provides a high definition broadcast studio that can connect with any television broadcaster around the world. To book an interview, please contact:


Ling L.M.,Tan Tock Seng Hospital | Chow A.L.,Clinical Epidemiology | Lye D.C.,Tan Tock Seng Hospital | Tan A.S.,Clinical Epidemiology | And 7 more authors.
Clinical Infectious Diseases | Year: 2010

Background. Pandemic influenza (H1N1) 2009 is susceptible to oseltamivir. There are few reports on its clinical and virologie response to oseltamivir. Methods. During the pandemic containment response in Singapore, all patients with positive polymerase chain reaction (PCR) results for pandemic influenza (H1N1) 2009 were hospitalized, given oseltamivir for 5 days, and discharged when daily PCR results for combined nasal and throat swab samples became negative. Six patients had concurrent positive viral culture and PCR results. Results. The median age of the first 70 consecutive patients was 26 years (interquartile range, 21-38 years); 60% were men, and 29% had comorbidity. The mean time ( ± SD) from illness onset to hospital admission was 3 ± 2 days. Influenza-like illness was noted in 63% of patients. Fever occurred in 91%, cough in 88%, sore throat in 66%, and rhinorrhea in 53% of patients. The mean duration (±SD) of viral shedding from illness onset was 6 ± 2 days. Viral shedding persisted beyond 7 days in 37% of patients. Clinical features and viral shedding were similar between those with and without comorbidity, except the former had more cough and lower oxygen saturation. Patients receiving oseltamivir on days 1 to 3 of illness had significantly shorter viral shedding duration, compared with those treated from day 4 onwards (P<.05 ). The mean durations (± SD) of positive PCR and viral culture results were 5 ± 0.8 and 4 ± 1.8 days, respectively, for 6 patients with concurrent positive viral culture and PCR results. Conclusions. Prolonged viral shedding was noted in young immunocompetent adults with mild pandemic influenza (H1N1) 2009 despite receipt of oseltamivir. When prescribed during the first 3 days of illness, oseltamivir shortened the duration of viral shedding. © 2010 by the Infectious Diseases Society of America. All rights reserved.


Arora N.K.,Clinical Epidemiology | Pillai R.,Clinical Epidemiology | Dasgupta R.,Jawaharlal Nehru University | Garg P.R.,Clinical Epidemiology
Annals of the New York Academy of Sciences | Year: 2014

India has experienced a rising prevalence of cardiometabolic risk factors in the past 15 years: the prevalence of diabetes has increased from 5.9% to 9.1%, hypertension from 17.2% to 29.2%, and obesity from 4% to 15%. The increase is among all socioeconomic groups and in urban and rural populations, though the quantum of change varies. A concomitant increase in per capita consumption of sugar from 22 to 55.3 g/day and total fat from 21.2 to 54 g/day was observed, with significant differences between states of high and low human development index (HDI). Per capita consumption of sugar, salt, and fat is consistently and significantly associated with overweight and obesity but variably associated with the occurrence of hypertension and diabetes. Market research shows that approximately 50-60% of total salt, sugar, and fat in Indian markets is procured by bulk purchasers, generally for manufacturing processed food items. This sector of the Indian economy is among the fastest growing, with several policy incentives. It is not clear from most of the data sets whether available information on per capita sugar, salt, and fat consumption has considered the contribution of processed and ready-to-eat food items. The unprecedented changes of rapid urbanization, mechanization, and globalization demand close monitoring of social, developmental, and economic determinants. This paper provides pieces of evidence to justify a whole-of-society (WoS) framework for monitoring the inputs, processes, and behavioral components of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in India. © 2014 New York Academy of Sciences.


Ng R.,McGill University | Bernatsky S.,McGill University | Rahme E.,Clinical Epidemiology
Journal of Rheumatology | Year: 2013

Objective. To determine how duration of observation affects estimation of incidence and prevalence of systemic lupus erythematosus (SLE). Methods. SLE incidence and prevalence estimates from data periods as brief as 3 years (2001-2003) were compared to estimates from a 15-year period (1989-2003). Results. The 15-year period incidence was 5.6/100,000 (95% CI 5.0-6.1) and the prevalence was 59.1/100,000 (95% CI 57.4-60.8). When a 3-year period was used, incidence was overestimated by 238.1% and prevalence underestimated by 66.0%. Conclusion. SLE incidence and prevalence estimates vary considerably according to the observation period; more than 5 years of data is likely required. Copyright © The Journal of Rheumatology 2013.

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