Statistics

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      "titulo" => "Kabuki syndrome with Sj&#246;gren Syndrome&#58; First case reported"
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    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Differences and Determinants of Physician&#39;s and Patient&#39;s Perception in Global Assessment of Rheumatoid Arthritis"
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        "autoresLista" => "Soraia Azevedo, Hugo Parente, Francisca Guimar&#227;es, Filipa Teixeira"
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            "entidad" => "Rheumatology Department&#44; Unidade Local de Sa&#250;de do Alto Minho&#44; Ponte de Lima&#44; Portugal"
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      "es" => array:1 [
        "titulo" => "Diferencias y determinantes de la percepci&#243;n del m&#233;dico y el paciente en la evaluaci&#243;n global de la artritis reumatoide"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Patient&#39;s Global Assessment of Disease Activity &#40;PtGA&#41; and Physician&#39;s Global Assessment of Disease Activity &#40;PhGA&#41; are assessed as part of disease activity in Rheumatoid Arthritis &#40;RA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Both are important measures in the treat-to-target strategies&#44; but often provide discordant results&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a> This can provide an erroneous assessment of the disease activity in patients and mislead treatment decisions&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We aimed to assess the differences and determinants of PtGA and PhGA in RA patients under biologic treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We performed a cross-sectional study&#44; including 46 patients with RA diagnosed according to the ACR&#47;EULAR criteria&#44; under biologic treatment&#46; A written informed consent was obtained&#46; Sociodemographic&#44; clinical data&#44; inflammatory parameters&#44; disease activity &#40;28-joint Disease Activity four variables Score &#40;DAS28 4V&#41; and patient-reported outcomes &#40;PROs&#41; were collected at same medical appointment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Variables with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;1 in the univariate analysis and those with clinical relevance were included in the multivariate analysis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical and laboratory characteristics of patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; PtGA and PhGA were significantly different &#40;36&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;6<span class="elsevierStyleHsp" style=""></span>mm <span class="elsevierStyleItalic">vs</span> 8&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;2<span class="elsevierStyleHsp" style=""></span>mm&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and a positive discordance &#40;PtGA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>PhGA&#44; more than 25<span class="elsevierStyleHsp" style=""></span>mm in visual analogue scale &#91;VAS&#93;&#41; was found in 54&#46;3&#37; of cases&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">PtGA had a strong correlation with PROs&#46; More elevated PtGA was associated with higher pain VAS&#44; Health Assessment Questionnaire &#91;HAQ&#93;&#44; and Hospital Anxiety and Depression Scale &#91;HADS&#93;&#41;&#44; C reactive protein &#40;CRP&#41;&#44; tender and swollen joint counts &#40;TJC and SJC&#44; respectively&#41; and with comorbidities like fibromyalgia or osteoarthritis &#40;OA&#41;&#44; and with lower 36-Item Short Form Health Survey &#91;SF-36&#93;&#44; Functional Assessment of Chronic Illness Therapy &#91;FACIT&#93;&#44; and EuroQol &#91;EQ5D&#93;&#46; No association was found between PtGA and age&#44; sex&#44; education level&#44; profession&#44; employment status&#44; extra-articular manifestations&#44; positivity of rheumatoid factor&#44; erythrocyte sedimentation rate &#40;ESR&#41;&#44; years of disease evolution or number of biologic treatments&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">SF-36 global score showed a strong correlation &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;750&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; with all of the other PROs and so it was the PRO included in the multivariate analysis&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the multivariate analysis including SF-36&#44; CRP&#44; TJC and OA &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;672&#41;&#44; the main predictors of PtGA were lower SF36&#44; concomitant OA and higher CRP level&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">PhGA had a correlation with pain VAS&#44; CRP&#44; TJC and SJC&#46; Higher PhGA was associated with higher pain VAS&#44; CRP&#44; TJC and SJC&#46; No association was found between PhGA and patient&#39;s or physician&#39;s age or gender&#44; extra-articular manifestations&#44; positivity of rheumatoid factor&#44; ESR level&#44; years of disease evolution or number of biologic treatments&#46; In the multivariable analysis including ESR&#44; TJC&#44; SJC&#44; and CRP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> adjusted<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;800&#41;&#44; the main predictors of the PhGA were SJC and higher CRP level&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This study report discordance between patients and physicians&#44; showing the variability implied on the global assessment of RA activity&#44; similar to literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;5</span></a> However&#44; to the best of our knowledge&#44; this is the first study demonstrating that concomitant OA and PROs are some of the major predictors of PtGA&#46; This highlights that patients&#8217; assessments are influenced by subjective domains such as personal needs&#44; priorities&#44; experiences&#44; and expectations&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Overall&#44; PtGA is based on function but also in subjective and emotional experience of pain&#44; whereas the PhGA is based on more objective measures&#44; more related to disease activity&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">VAS&#58; Visual Analogic Scale&#59; CRP&#58; C-reactive protein&#59; ESR&#58; erythrocyte sedimentation rate&#59; HAQ&#58; Health Assessment Questionnaire&#59; DAS 28&#58; Disease Activity Score&#59; SDAI&#58; Simple Disease Activity Index&#59; CDAI&#58; Clinical Disease Activity Index&#59; EQ5D&#58; EuroQol-5 dimension&#59; FACIT&#58; Functional Assessment of Chronic Illness Therapy&#59; HADS&#58; Hospital Anxiety and Depression&#59; SD&#58; Standard Deviation&#46;</p>"
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                  \t\t\t\t">Age &#40;years&#41;&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">58&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Gender &#8211; female&#44; &#37; &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">69&#46;6&#37; &#40;32&#47;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Years from diagnosis&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Biologic DMARD position&#44; &#37; &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1<span class="elsevierStyleSup">st</span>&#58; 58&#46;7&#37; &#40;27&#47;46&#41;2<span class="elsevierStyleSup">nd</span>&#58; 28&#46;3&#37; &#40;13&#47;46&#41;Others&#58; 13&#46;0&#37; &#40;6&#47;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Patient Global VAS&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40&#46;0 &#40;50&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Patient pain VAS&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">31&#46;0 &#40;45&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Physician Global VAS&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;0 &#40;<span class="elsevierStyleItalic">15&#46;0&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Positive discordance &#37; &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Tender joints &#40;<span class="elsevierStyleItalic">n</span>&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;0 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Swollen joints &#40;<span class="elsevierStyleItalic">n</span>&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;0 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">CRP &#40;mg&#47;dL&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;3 &#40;0&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ESR &#40;mm&#47;hr&#41;&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">HAQ&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;0 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">DAS28 4V&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">SDAI&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CDAI&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Short Form &#40;36&#41; Health Survey &#40;SF36&#41;&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FACIT&#44; mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">34&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">HADS&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Anxiety&#58; 7 &#40;7&#41;Depression&#58; 6 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EQ5D&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;32 &#40;0&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Comorbidities&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&#46;4&#37; &#40;8&#47;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Depression&#47;Anxiety&#44; &#37; &#40;<span class="elsevierStyleItalic">n</span>&#47;<span class="elsevierStyleItalic">N</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;7&#37; &#40;4&#47;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">28&#46;3&#37; &#40;13&#47;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4&#46;3&#37; &#40;2&#47;46&#41;&nbsp;\t\t\t\t\t\t\n
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