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I read with great interest this article by Johnson et al. and have the following comment.

As mentioned in this section, by selecting participants from Lyme Disease support forums you may only be finding the sickest individuals. But, due to condition of study and the methods employed, individuals with underlying psychological issues may also be more likely to be identified and sampled. The subje...

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Analysis of sex differences could provide yet even more information regarding the phenomenon studied. The study was successful in attracting a large number of respondents with 3,090 respondents entered into the study. We are also told the respondents were predominately female (>80%), but that does not necessarily translate into how each sex would answer a particular question. The study of sex diff...

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In addition to the limitation described above, I feel that another should also be incorporated.

In order to compare quality of life and healthcare utilization across various disease states and the general population, the authors extracted data from prior published literature. It is not clear how similar or different these populations were and there was not an effort to quantify these differenc...

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