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Stovitz SD. Pooled RCTs: Low-dose ASA reduced CV events in persons < 70 kg; higher-dose ASA was effective at higher body weights. Ann Intern Med 2018; 169:JC57. [PMID: 30452564 DOI: 10.7326/acpjc-2018-169-10-057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Krachler B, Stovitz SD. How body composition may confound effect estimates of cardiorespiratory fitness. Eur J Prev Cardiol 2018; 26:196-198. [PMID: 30428266 DOI: 10.1177/2047487318812507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stovitz SD, Banack HR, Kaufman JS. 'Depletion of the susceptibles' taught through a story, a table and basic arithmetic. BMJ Evid Based Med 2018; 23:199. [PMID: 29982175 DOI: 10.1136/bmjebm-2018-110972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/04/2022]
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Stovitz SD, Banack HR, Kaufman JS. Paediatric obesity appears to lower the risk of diabetes if selection bias is ignored. J Epidemiol Community Health 2018; 72:302-308. [PMID: 29374028 DOI: 10.1136/jech-2017-209985] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/04/2017] [Accepted: 12/18/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Frustrated with the onslaught of articles reporting fascination with results that appear paradoxical but are merely due to selection bias, we studied the apparent effect of obesity on diabetes risk in youth who had a test for diabetes. We hypothesised that obese subjects would have lower rates of diabetes than non-obese subjects due to selection bias, and consequently, obesity would appear to lower the risk of diabetes. METHODS Retrospective cohort study of children (4-9 years), pre-teens (10-12 years) and teenagers (13-19 years). Participation was restricted to those who had a test of haemoglobin A1C along with measured height and weight. Body mass index percentile via the Centers for Disease Control and Prevention age and sex standards was calculated and categorised. The main outcome was A1C%, subsequently categorised at the level for diagnosis of diabetes mellitus (≥6.5%). RESULTS The sample consisted of 134 (2%) underweight, 1718 (30%) healthy weight, 660 (12%) overweight and 3190 (56%) obese individuals. 16% (n=936) had an A1C≥6.5%. Overall, healthy weight children had 8.2 times the risk of A1C≥6.5% (95% CI 5.3 to 12.7) compared with those in the obese category. The relative risk was 13 in pre-teens (95% CI 8.5 to 20.0) and 3.9 in teenagers (95% CI 3.3 to 4.7). CONCLUSIONS Healthy weight was associated with a 4-13 times higher relative risk of diabetes mellitus compared with being obese. While apparently shocking, the study's fatal flaw (selection bias) explains the 'paradoxical' finding. Ignoring selection bias can delay advances in medical science.
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Nielsen RO, Chapman CM, Louis WR, Stovitz SD, Mansournia MA, Windt J, Møller M, Parner ET, Hulme A, Bertelsen ML, Finch CF, Casals M, Verhagen E. Seven sins when interpreting statistics in sports injury science. Br J Sports Med 2017; 52:1410-1412. [PMID: 29263023 DOI: 10.1136/bjsports-2017-098524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 12/12/2022]
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Krachler B, Stovitz SD. Cardiorespiratory Fitness is a Function of Fat-Free Mass. Am J Cardiol 2017; 120:2119. [PMID: 28958453 DOI: 10.1016/j.amjcard.2017.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/08/2017] [Indexed: 11/28/2022]
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Stovitz SD, Verhagen E, Shrier I. Distinguishing between causal and non-causal associations: implications for sports medicine clinicians. Br J Sports Med 2017; 53:398-399. [PMID: 29162620 DOI: 10.1136/bjsports-2017-098520] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 01/05/2023]
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Stovitz SD, Banack HR, Kaufman JS. Structural Bias in Studies of Cardiovascular Disease: Let's Not Be Fooled by the "Obesity Paradox". Can J Cardiol 2017; 34:540-542. [PMID: 29289401 DOI: 10.1016/j.cjca.2017.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 01/03/2023] Open
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Satin DJ, Swenson SA, Stovitz SD. Effectively engaging patients in everyday health-care decisions. THE JOURNAL OF FAMILY PRACTICE 2017; 66:E1-E6. [PMID: 28991937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
You can improve health outcomes and patient satisfaction--without increasing the length of the patient visit--by employing the tenets of shared decision-making.
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Verhagen E, Stovitz SD, Mansournia MA, Nielsen RO, Shrier I. BJSM educational editorials: methods matter. Br J Sports Med 2017; 52:1159-1160. [DOI: 10.1136/bjsports-2017-097998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 11/04/2022]
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Berge JM, Adamek M, Caspi C, Loth KA, Shanafelt A, Stovitz SD, Trofholz A, Grannon KY, Nanney MS. Healthy Eating and Activity Across the Lifespan (HEAL): A call to action to integrate research, clinical practice, policy, and community resources to address weight-related health disparities. Prev Med 2017. [PMID: 28647543 DOI: 10.1016/j.ypmed.2017.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite intense nationwide efforts to improve healthy eating and physical activity across the lifespan, progress has plateaued. Moreover, health inequities remain. Frameworks that integrate research, clinical practice, policy, and community resources to address weight-related behaviors are needed. Implementation and evaluation of integration efforts also remain a challenge. The purpose of this paper is to: (1) Describe the planning and development process of an integrator entity, HEAL (Healthy Eating and Activity across the Lifespan); (2) present outcomes of the HEAL development process including the HEAL vision, mission, and values statements; (3) define the planned integrator functions of HEAL; and (4) describe the ongoing evaluation of the integration process. HEAL team members used a theoretically-driven, evidence-based, systemic, twelve-month planning process to guide the development of HEAL and to lay the foundation for short- and long-term integration initiatives. Key development activities included a review of the literature and case studies, identifying guiding principles and infrastructure needs, conducting stakeholder/key informant interviews, and continuous capacity building among team members. Outcomes/deliverables of the first year of HEAL included a mission, vision, and values statements; definitions of integration and integrator functions and roles; a set of long-range plans; and an integration evaluation plan. Application of the HEAL integration model is currently underway through community solicited initiatives. Overall, HEAL aims to lead real world integrative work that coalesce across research, clinical practice, and policy with community resources to inspire a culture of health equity aimed at improving healthy eating and physical activity across the lifespan.
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Peterson RL, Tran M, Koffel J, Stovitz SD. Statistical testing of baseline differences in sports medicine RCTs: a systematic evaluation. BMJ Open Sport Exerc Med 2017; 3:e000228. [PMID: 28761712 PMCID: PMC5530118 DOI: 10.1136/bmjsem-2017-000228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 04/18/2017] [Accepted: 05/03/2017] [Indexed: 11/11/2022] Open
Abstract
Background/Aim The CONSORT (Consolidated Standards of Reporting Trials) statement discourages reporting statistical tests of baseline differences between groups in randomised controlled trials (RCTs). However, this practice is still common in many medical fields. Our aim was to determine the prevalence of this practice in leading sports medicine journals. Methods We conducted a comprehensive search in Medline through PubMed to identify RCTs published in the years 2005 and 2015 from 10 high-impact sports medicine journals. Two reviewers independently confirmed the trial design and reached consensus on which articles contained statistical tests of baseline differences. Results Our search strategy identified a total of 324 RCTs, with 85 from the year 2005 and 239 from the year 2015. Overall, 64.8% of studies (95% CI (59.6, 70.0)) reported statistical tests of baseline differences; broken down by year, this percentage was 67.1% in 2005 (95% CI (57.1, 77.1)) and 64.0% in 2015 (95% CI (57.9, 70.1)). Conclusions Although discouraged by the CONSORT statement, statistical testing of baseline differences remains highly prevalent in sports medicine RCTs. Statistical testing of baseline differences can mislead authors; for example, by failing to identify meaningful baseline differences in small studies. Journals that ask authors to follow the CONSORT statement guidelines should recognise that many manuscripts are ignoring the recommendation against statistical testing of baseline differences.
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Weber J, Hu C, Roberts WO, Lane KR, Stovitz SD. Hip Injury- Marathon. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518823.16677.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stovitz SD. 1296. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517840.24441.a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Stovitz SD, Shrier I. Which estimates comprise optimal reporting in Systematic Reviews? J Clin Epidemiol 2017; 81:140. [DOI: 10.1016/j.jclinepi.2016.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/15/2016] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
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Popp KL, McDermott W, Hughes JM, Baxter SA, Stovitz SD, Petit MA. Bone strength estimates relative to vertical ground reaction force discriminates women runners with stress fracture history. Bone 2017; 94:22-28. [PMID: 27729292 DOI: 10.1016/j.bone.2016.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine differences in bone geometry, estimates of bone strength, muscle size and bone strength relative to load, in women runners with and without a history of stress fracture. METHODS We recruited 32 competitive distance runners aged 18-35, with (SFX, n=16) or without (NSFX, n=16) a history of stress fracture for this case-control study. Peripheral quantitative computed tomography (pQCT) was used to assess volumetric bone mineral density (vBMD, mg/mm3), total (ToA) and cortical (CtA) bone areas (mm2), and estimated compressive bone strength (bone strength index; BSI, mg/mm4) at the distal tibia. ToA, CtA, cortical vBMD, and estimated strength (section modulus; Zp, mm3 and strength strain index; SSIp, mm3) were measured at six cortical sites along the tibia. Mean active peak vertical (pkZ) ground reaction forces (GRFs), assessed from a fatigue run on an instrumented treadmill, were used in conjunction with pQCT measurements to estimate bone strength relative to load (mm2/N∗kg-1) at all cortical sites. RESULTS SSIp and Zp were 9-11% lower in the SFX group at mid-shaft of the tibia, while ToA and vBMD did not differ between groups at any measurement site. The SFX group had 11-17% lower bone strength relative to mean pkZ GRFs (p<0.05). CONCLUSION These findings indicate that estimated bone strength at the mid-tibia and mean pkZ GRFs are lower in runners with a history of stress fracture. Bone strength relative to load is also lower in this same region suggesting that strength deficits in the middle 1/3 of the tibia and altered gait biomechanics may predispose an individual to stress fracture.
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Stovitz SD, Satin DJ, Shrier I. Shared Decision Making Regarding Aspirin in Primary Prevention of Cardiovascular Disease. JAMA 2016; 316:2276. [PMID: 27923084 DOI: 10.1001/jama.2016.16748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Stovitz SD, Verhagen E, Shrier I. Misinterpretations of the ‘p value’: a brief primer for academic sports medicine. Br J Sports Med 2016; 51:1176-1177. [DOI: 10.1136/bjsports-2016-097072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/04/2022]
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Gorman M, Hecht S, Samborski A, Lunos S, Elias S, Stovitz SD. SCAT3 assessment of non-head injured and head injured athletes competing in a large international youth soccer tournament. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:364-368. [PMID: 27484942 DOI: 10.1080/21622965.2016.1210011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To our knowledge, no study has evaluated Sideline Concussion Assessment Tool -3rd Edition (SCAT3) scores during competition in athletes who have not had a head injury. The purpose of our pilot study was to compare SCAT3 scores in non-injured (NI), injured (but not head injured) (I), and head injured (HI) youth soccer players during competition and to establish preliminary baseline data for non-head injured athletes in a competitive setting. The HI group demonstrated significantly more symptoms (M = 9.7, SE = 0.8) than the I and NI (3.3, SE = 1.2, and 3.2, SE = 0.7, respectively) groups. The HI group also demonstrated a significantly higher symptom severity score (25.3, SE = 2.8) than the I and NI groups (7.7, SE = 4.1, and 5.9, SE = 2.5, respectively). There were no statistically significant differences in mean total Standardized Assessment of Concussion (SAC) scores and mean subsection SAC scores between the groups. Clinicians should also be aware that non-injured in-competition athletes may report more symptoms on the SCAT3 than those evaluated in a non-competition setting.
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Stovitz SD. 1834. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486507.92326.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roberts WO, Ryan MC, Macalena JA, Stovitz SD. Knee Pain That Wasn’t in a Twin Cities Marathon Finisher. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000485530.03921.9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shrier I, Steele RJ, Zhao M, Naimi A, Verhagen E, Stovitz SD, Rauh MJ, Hewett TE. A multistate framework for the analysis of subsequent injury in sport (M-FASIS). Scand J Med Sci Sports 2015; 26:128-39. [PMID: 26040301 DOI: 10.1111/sms.12493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2015] [Indexed: 11/28/2022]
Abstract
Physical activity is beneficial for many aspects of health but is associated with a risk of injury. Studies that assess causal risk factors of injury and reinjury provide valuable information to help develop and improve injury prevention programs. However, the underlying assumptions of analytical approaches often used to estimate causal factors in injury and subsequent injury research are often violated. This means that ineffective or even harmful interventions could be proposed because the underlying analyses produced unreliable or invalid causal effect estimates. We describe an adapted version of the multistate framework [multistate framework for the analysis of subsequent injury in sport (M-FASIS)] that makes investigator choices more transparent with respect to outcome and healing time. In addition, M-FASIS incorporates all previous sport injury analytical frameworks and accounts for injuries or conditions that heal or do not heal to 100%, acute and overuse injuries, illnesses, and competing event outcomes.
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