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Shrier I, Impellizzeri FM, Stovitz SD. Identifying and Minimizing Incentives for Competing Interests in Sports Medicine Publications. Sports Med 2024:10.1007/s40279-024-02037-w. [PMID: 38714641 DOI: 10.1007/s40279-024-02037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/10/2024]
Abstract
Academics in sports medicine as well as other medical fields are generally expected to publish research and opinions in peer-reviewed journals. The peer-review process is intended to protect against the publication of flawed research and unsubstantiated claims. However, both financial and non-financial competing interests may result in sub-optimal results by affecting investigators, editors, peer reviewers, academic institutions, and publishers. In this article, we focus on the non-financial competing interests created in our current academic system. Because these competing interests are embedded in our current scholastic framework, the potential biases are difficult to quantify. To minimize the effect of these competing interests, we review and highlight some underlying incentives for each stakeholder and some potential solutions to mitigate their effects.
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Affiliation(s)
- Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Cote Sainte Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Franco M Impellizzeri
- School of Sport, Exercise and Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minnesota, USA
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2
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Stovitz SD. Re: Becoming a Phronimos: Evidence-Based Medicine, Clinical Decision Making and the Role of Practical Wisdom in Primary Care. J Am Board Fam Med 2024:jabfm.2023.230325R0. [PMID: 38365313 DOI: 10.3122/jabfm.2023.230325r0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Affiliation(s)
- Steven D Stovitz
- From the Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN.
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3
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Shrier I, Stovitz SD, Textor J. Identifiability of causal effects in test-negative design studies. Int J Epidemiol 2023; 52:1968-1974. [PMID: 37451683 DOI: 10.1093/ije/dyad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Causal directed acyclic graphs (DAGs) are often used to select variables in a regression model to identify causal effects. Outcome-based sampling studies, such as the 'test-negative design' used to assess vaccine effectiveness, present unique challenges that are not addressed by the common back-door criterion. Here we discuss intuitive, graphical approaches to explain why the common back-door criterion cannot be used for identification of population average causal effects with outcome-based sampling studies. We also describe graphical rules that can be used instead in outcome-based sampling studies when the objective is limited to determining if the causal odds ratio is identifiable, and illustrate recent changes to the free online software Dagitty which incorporate these principles.
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Affiliation(s)
- Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Johannes Textor
- Department of Tumour Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
- Data Science group, Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
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Shrier I, Impellizzeri FM, Stovitz SD. Prevention versus risk reduction or mitigation: Why create unnecessary battles? J Sci Med Sport 2023:S1440-2440(23)00130-5. [PMID: 37391285 DOI: 10.1016/j.jsams.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Canada.
| | - Franco M Impellizzeri
- School of Sport, Exercise and Rehabilitation, Faculty of Health, University of Technology Sydney, Australia
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, USA. https://twitter.com/StevenStovitz
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Wiggen TD, Bohn B, Ulrich AK, Stovitz SD, Strickland AJ, Naumchik BM, Walsh S, Smith S, Baumgartner B, Kline S, Yendell S, Hedberg C, Beebe TJ, Demmer RT. SARS-CoV-2 seroprevalence among healthcare workers. PLoS One 2022; 17:e0266410. [PMID: 35468153 PMCID: PMC9037906 DOI: 10.1371/journal.pone.0266410] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/18/2022] [Indexed: 01/12/2023] Open
Abstract
Background
Monitoring COVID-19 infection risk among health care workers (HCWs) is a public health priority. We examined the seroprevalence of SARS-CoV-2 among HCWs following the fall infection surge in Minnesota, and before and after COVID-19 vaccination. Additionally, we assessed demographic and occupational risk factors for SARS-CoV-2 infection.
Methods
We conducted two rounds of seroprevalence testing among a cohort of HCWs: samples in round 1 were collected from 11/22/20–02/21/21 and in round 2 from 12/18/20–02/15/21. Demographic and occupational exposures assessed with logistic regression were age, sex, healthcare role and setting, and number of children in the household. The primary outcome was SARS-CoV-2 IgG seropositivity. A secondary outcome, SARS-CoV-2 infection, included both seropositivity and self-reported SARS-CoV-2 test positivity.
Results
In total, 459 HCWs were tested. 43/454 (9.47%) had a seropositive sample 1 and 75/423 (17.7%) had a seropositive sample 2. By time of sample 2 collection, 54% of participants had received at least one vaccine dose and seroprevalence was 13% among unvaccinated individuals. Relative to physicians, the odds of SARS-CoV-2 infection in other roles were increased (Nurse Practitioner: OR[95%CI] 1.93[0.57,6.53], Physician’s Assistant: 1.69[0.38,7.52], Nurse: 2.33[0.94,5.78], Paramedic/EMTs: 3.86[0.78,19.0], other: 1.68[0.58,4.85]). The workplace setting was associated with SARS-CoV-2 infection (p = 0.04). SARS-CoV-2 seroprevalence among HCWs reporting duties in the ICU vs. those working in an ambulatory clinic was elevated: OR[95%CI] 2.17[1.01,4.68].
Conclusions
SARS-CoV-2 seroprevalence in HCW increased during our study period which was consistent with community infection rates. HCW role and setting—particularly working in the ICU—is associated with higher risk for SARS-CoV-2 infection.
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Affiliation(s)
- Talia D. Wiggen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Angela K. Ulrich
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN, United States of America
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Steven D. Stovitz
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN, United States of America
| | - Ali J. Strickland
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Brianna M. Naumchik
- Medical School, University of Minnesota, Minneapolis, MN, United States of America
| | - Sara Walsh
- NORC at the University of Chicago, Health Sciences, Chicago, IL, United States of America
| | - Stephen Smith
- NORC at the University of Chicago, Health Sciences, Chicago, IL, United States of America
| | | | - Susan Kline
- Division of Infectious Diseases and International Medicine, Medical School, University of Minnesota, Minneapolis, MN, United States of America
| | - Stephanie Yendell
- Minnesota Department of Health, St. Paul, MN, United States of America
| | - Craig Hedberg
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Timothy J. Beebe
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Ryan T. Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- * E-mail: ,
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Shrier I, Stovitz SD, Wang C, Steele RJ. Beware of collider stratification bias when analyzing recurrent injuries. Scand J Med Sci Sports 2022; 32:270-272. [PMID: 35020225 DOI: 10.1111/sms.14093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/10/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chinchin Wang
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
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Abstract
Favresse J, Gillot C, Oliveira M, et al. Head-to-head comparison of rapid and automated antigen detection tests for the diagnosis of SARS-CoV-2 infection. J Clin Med. 2021;10:265. 33450853.
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Stovitz SD, Shrier I. Does my patient have SARS-CoV-2 infection? A reminder of clinical probability formulas. BMJ Evid Based Med 2021; 26:bmjebm-2020-111633. [PMID: 33849987 PMCID: PMC8050872 DOI: 10.1136/bmjebm-2020-111633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota System, Minneapolis, Minnesota, USA
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, McGill University, Montreal, Québec, Canada
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Stovitz SD, Thompson JA, Demmer RT. Beware of the Differing Definitions for the False-Positive Rate. Am Fam Physician 2021; 103:7-8. [PMID: 33382570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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10
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Bonikowske AR, Carpenter KC, Stovitz SD, Bandyopadhyay D, Pereira MA, Lewis BA. Acute Effect of Height-Adjustable Workstations on Blood Glucose Levels in Women with Impaired Fasting Glucose Levels While Working: A Pilot Study. Transl J ACSM 2021; 6. [DOI: 10.1249/tjx.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Stovitz SD, Banack HR, Kaufman JS. Selection bias can creep into unselected cohorts and produce counterintuitive findings. Int J Obes (Lond) 2020; 45:276-277. [PMID: 33235356 DOI: 10.1038/s41366-020-00720-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/27/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Hailey R Banack
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, New York, New York, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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12
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Demmer RT, Ulrich AK, Wiggen TD, Strickland A, Naumchik BM, Kulasingam S, Stovitz SD, Marotz C, Belda-Ferre P, Humphrey G, De Hoff P, Laurent L, Kline S, Knight R. SARS-CoV-2 Screening Among Symptom-Free Healthcare Workers. medRxiv 2020. [PMID: 32793921 DOI: 10.1101/2020.07.31.20166066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is possible among symptom-free individuals and some patients are avoiding medically necessary healthcare visits for fear of becoming infected in the healthcare setting. Limited data are available on the point prevalence of SARS-CoV-2 infection in symptom-free U.S. healthcare workers (HCW). Methods A cross-sectional convenience sample of symptom-free HCWs from the metropolitan area surrounding Minneapolis and St. Paul, Minnesota was enrolled between April 20 th and June 24 th , 2020. A participant self-collected nasopharyngeal swab (NPS) was obtained. SARS-CoV-2 infection was assessed via polymerase chain reaction. Participants were queried about their willingness to repeat a self-collection NPS for diagnostic purposes. We had >95% power to detect at least one positive test if the true underlying prevalence of SARS-CoV2 was ≥1%. Results Among n=489 participants 80% were female and mean age±SD was 41±11. Participants reported being physicians (14%), nurse practitioners (8%), physician's assistants (4%), nurses (51%), medics (3%), or other which predominantly included laboratory technicians and administrative roles (22%). Exposure to a known/suspected COVID-19 case in the 14 days prior to enrollment was reported in 40% of participants. SARS-CoV-2 was not detected in any participant. Over 95% of participants reported a willingness to repeat a self-collected NP swab in the future. Conclusions The point prevalence of SARS-CoV-2 infection was likely <1% in a convenience sample of symptom-free Minnesota healthcare workers from April 20 th and June 24 th , 2020. Self-collected NP swabs are well-tolerated and a viable alternative to provider-collected swabs to preserve PPE.
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El-Khoury J, Stovitz SD, Shrier I. Estimating unbiased sports injury rates: a compendium of injury rates calculated by athlete exposure and athlete at risk methods. Br J Sports Med 2020; 55:bjsports-2020-102456. [PMID: 32998868 DOI: 10.1136/bjsports-2020-102456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Joseph El-Khoury
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
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Abstract
BACKGROUND Previous studies suggest that many physicians and medical trainees have trouble calculating the probability that a patient has a condition, also known as the predictive value. ACTIVITY Two questions from the medical literature were administered to medical students, residents (post-medical school), fellows (post-residency), and faculty physicians. RESULTS Only 6% answered both questions correctly. Most commonly, the participants grossly overestimated the probability of disease. DISCUSSION Physicians still struggle with the ability to calculate predictive values, a skill that affects all branches of medicine and will become more consequential as new tests are administered to patients at low risk for disease.
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Affiliation(s)
- Steven D. Stovitz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 420 Delaware St. SE, MMC 381, Minneapolis, MN 55455 USA
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15
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Stovitz SD. Coronavirus (COVID-19) Assessments and the Importance of Calculating the Probability of Illness. Med Sci Educ 2020; 30:669-670. [PMID: 32328341 PMCID: PMC7176373 DOI: 10.1007/s40670-020-00964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Steven D. Stovitz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 420 Delaware St. SE, MMC 381, Minneapolis, MN 55455 USA
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16
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Banack HR, Kaufman JS, Stovitz SD. RE: "INVESTIGATION OF THE OBESITY PARADOX IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ACCORDING TO SMOKING STATUS, IN THE UNITED STATES". Am J Epidemiol 2020; 189:481-482. [PMID: 31673699 DOI: 10.1093/aje/kwz244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hailey R Banack
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN
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17
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Stovitz SD, Shrier I, Kaufman JS. What Was the Goal of the Analysis? Am J Med 2020; 133:e213-e214. [PMID: 32450957 DOI: 10.1016/j.amjmed.2020.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Steven D Stovitz
- Professor Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minn.
| | - Ian Shrier
- Associate Professor Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jay S Kaufman
- Professor Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Kaufman JS, Banack HR, Adams JW, Marshall BDL, Stovitz SD. Risk Factor Reversal in Studies of Infectious Disease: Making Counterintuitive Results Intuitive Again. Sex Transm Dis 2020; 46:e5-e7. [PMID: 30234795 DOI: 10.1097/olq.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A previously published study reported the seemingly paradoxical finding that men who have sex with men status was strongly protective and recent sexual abstinence strongly deleterious in relation to mortality prognosis. We explain why these results are entirely logical and that the counterintuitive direction of the effects derives from the comparison group implied by the study design.
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Affiliation(s)
- Jay S Kaufman
- From the Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Montreal, QC, Canada
| | - Hailey R Banack
- Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo, The State University of New York, Buffalo, NY
| | - Joëlla W Adams
- Department of Epidemiology Brown University School of Public Health, Providence, RI, and
| | - Brandon D L Marshall
- Department of Epidemiology Brown University School of Public Health, Providence, RI, and
| | - Steven D Stovitz
- Department of Family Medicine and Community Health University of Minnesota, Minneapolis, MN
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Stovitz SD, Shrier I. Letter to the Editor. Curr Sports Med Rep 2020; 19:95. [PMID: 32028354 DOI: 10.1249/jsr.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Popp KL, Frye AC, Stovitz SD, Hughes JM. Bone geometry and lower extremity bone stress injuries in male runners. J Sci Med Sport 2019; 23:145-150. [PMID: 31594711 DOI: 10.1016/j.jsams.2019.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/13/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
Bone stress injuries (BSI) are common among distance runners and research investigations examining risk factors for BSI among men are limited. Therefore, investigations are needed to determine if men with a history of BSI have skeletal properties that may heighten BSI incidence. OBJECTIVES To analyze differences in bone density, bone geometry, and estimates of bone strength in male runners with and without a BSI history. DESIGN Cross-sectional. METHODS We recruited 36 male distance runners ages 18-41 for this study. We used peripheral quantitative computed tomography (pQCT) to assess volumetric bone mineral density (vBMD, mg/mm3), bone geometry (total and cortical bone area, mm2), tibia robustness (total area/tibia length, mm) and estimates of bone strength (section modulus and polar strength-strain index, mm3) at 5 tibial sites. RESULTS After adjusting for age, the BSI group had more slender tibias (9%), lower stress strain indices (-16%), lower section moduli (-17%) and smaller total cross-sectional (-11%) and cortical areas (-12%) at the 66% site of the tibia compared with controls (P < 0.05 for all). Similar differences were found at all other measurement sites. After adjusting for body size, differences in bone outcomes remained significant at the 66% site. CONCLUSIONS These results indicate that men with a history of BSI have lower estimated bending strength compared to controls because of narrower tibias. However, differences are largely attenuated in the distal ½ of the tibia after adjusting for body size. Thus, smaller tibia size, particularly at the mid-diaphysis, may be an important indicator for BSI incidence.
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Affiliation(s)
- Kristin L Popp
- Military Performance Division, United States Army Research Institute of Environmental, USA; Endocrine Unit, Massachusetts General Hospital, USA; Department of Medicine, Harvard Medical School, USA.
| | - Adam C Frye
- Laboratory of Musculoskeletal Health, School of Kinesiology, University of Minnesota, USA
| | | | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental, USA
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Banack HR, Kaufman JS, Wactawski-Wende J, Troen BR, Stovitz SD. Investigating and Remediating Selection Bias in Geriatrics Research: The Selection Bias Toolkit. J Am Geriatr Soc 2019; 67:1970-1976. [PMID: 31211407 PMCID: PMC9930538 DOI: 10.1111/jgs.16022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 04/05/2019] [Accepted: 05/15/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Selection bias is a well-known concern in research on older adults. We discuss two common forms of selection bias in aging research: (1) survivor bias and (2) bias due to loss to follow-up. Our objective was to review these two forms of selection bias in geriatrics research. In clinical aging research, selection bias is a particular concern because all participants must have survived to old age, and be healthy enough, to take part in a research study in geriatrics. DESIGN We demonstrate the key issues related to selection bias using three case studies focused on obesity, a common clinical risk factor in older adults. We also created a Selection Bias Toolkit that includes strategies to prevent selection bias when designing a research study in older adults and analytic techniques that can be used to examine, and correct for, the influence of selection bias in geriatrics research. RESULTS Survivor bias and bias due to loss to follow-up can distort study results in geriatric populations. Key steps to avoid selection bias at the study design stage include creating causal diagrams, minimizing barriers to participation, and measuring variables that predict loss to follow-up. The Selection Bias Toolkit details several analytic strategies available to geriatrics researchers to examine and correct for selection bias (eg, regression modeling and sensitivity analysis). CONCLUSION The toolkit is designed to provide a broad overview of methods available to examine and correct for selection bias. It is specifically intended for use in the context of aging research. J Am Geriatr Soc 67:1970-1976, 2019.
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Affiliation(s)
- Hailey R. Banack
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Jay S. Kaufman
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Bruce R. Troen
- Division of Geriatrics and Palliative Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo and Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York
| | - Steven D. Stovitz
- Department of Family Medicine and Community Health, University of Minnesota System, Minneapolis, Minnesota
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Stovitz SD, Mandrola J. Prognosis is Different than Treatment Effect. Am J Cardiol 2019; 124:322-323. [PMID: 31084995 DOI: 10.1016/j.amjcard.2019.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
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Abstract
Evidence-based medicine (EBM) calls on clinicians to incorporate the 'best available evidence' into clinical decision-making. For decisions regarding treatment, the best evidence is that which determines the causal effect of treatments on the clinical outcomes of interest. Unfortunately, research often provides evidence where associations are not due to cause-and-effect, but rather due to non-causal reasons. These non-causal associations may provide valid evidence for diagnosis or prognosis, but biased evidence for treatment effects. Causal inference aims to determine when we can infer that associations are or are not due to causal effects. Since recommending treatments that do not have beneficial causal effects will not improve health, causal inference can advance the practice of EBM. The purpose of this article is to familiarise clinicians with some of the concepts and terminology that are being used in the field of causal inference, including graphical diagrams known as 'causal directed acyclic graphs'. In order to demonstrate some of the links between causal inference methods and clinical treatment decision-making, we use a clinical vignette of assessing treatments to lower cardiovascular risk. As the field of causal inference advances, clinicians familiar with the methods and terminology will be able to improve their adherence to the principles of EBM by distinguishing causal effects of treatment from results due to non-causal associations that may be a source of bias.
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Affiliation(s)
- Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota System, Minneapolis, Minnesota, USA
| | - Ian Shrier
- Department of Epidemiology, Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
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Baggish AL, Cole BJ, Gladden LB, Hutchinson MR, Putukian M, Stovitz SD, Best TM. Team Physician, Team Subspecialist: A Potential Scientific Conflict of Interest? Med Sci Sports Exerc 2019; 51:393-394. [PMID: 30768583 DOI: 10.1249/mss.0000000000001874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Aaron L Baggish
- Cardiovascular Performance Program, Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Brian J Cole
- Departments of Orthopedics and Surgery, Rush University Medical Center, Chicago, IL
| | | | - Mark R Hutchinson
- Sports Medicine Services, Department of Orthopedics, University of Illinois at Chicago, Chicago, IL
| | - Margot Putukian
- University Health Services, Athletic Medicine, Princeton University, Princeton, NJ
| | - Steven D Stovitz
- University of Minnesota, Department of Family Medicine and Community Health, Minneapolis, MN
| | - Thomas M Best
- Miami Sports Medicine Institute, Departments of Orthopedics, Biomedical Engineering, Kinesiology, University of Miami, Coral Gables, FL
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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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Steven D. Stovitz
- University of MinnesotaDepartment of Family Medicine and Community HealthMinneapolis, Minnesota, USA
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Affiliation(s)
- Benno Krachler
- 1 Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Steven D Stovitz
- 2 Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
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Affiliation(s)
- Steven D Stovitz
- Family Medicine and Community Health, University of Minnesota System, Minneapolis, Minnesota, USA
| | - Hailey R Banack
- Epidemiology and Environmental Health, University at Buffalo-The State University of New York, Buffalo, New York, USA
| | - Jay S Kaufman
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hailey R Banack
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - Cassandra M Chapman
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Winnifred R Louis
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Johann Windt
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Queensland, Australia
| | | | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia
| | - Marti Casals
- Sport Performance Analysis Research Group, University of Vic, Barcelona, Spain.,Research Centre Network for Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports and Department of Public and Occupational Health, Amsterdam Movement Science, VU University Medical Center, Amsterdam, The Netherlands
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
Affiliation(s)
- Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
| | - Hailey R Banack
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
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Satin DJ, Swenson SA, Stovitz SD. Effectively engaging patients in everyday health-care decisions. J Fam Pract 2017; 66:E1-E6. [PMID: 28991937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- David J Satin
- University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Sarah A Swenson
- University of Minnesota Medical School, Minneapolis, MN, USA
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota, United States.
| | | | - Caitlin Caspi
- Department of Family Medicine and Community Health, Division of Health Disparities, University of Minnesota, United States
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota, United States
| | - Amy Shanafelt
- Clinical and Translation Science Institute, University of Minnesota, United States
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, United States
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, United States
| | - Katherine Y Grannon
- Department of Family Medicine and Community Health, Division of Health Disparities, University of Minnesota, United States
| | - Marilyn S Nanney
- Department of Family Medicine and Community Health, Division of Health Disparities, University of Minnesota, United States
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Ross L Peterson
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Matthew Tran
- College of Biological Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Jonathan Koffel
- Health Sciences Libraries, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Steven D Stovitz
- Family Medicine and Community Health, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Kristin L Popp
- School of Kinesiology, Laboratory of Musculoskeletal Health, University of Minnesota, 1900 University Ave SE, Minneapolis, MN 55455, USA.
| | - William McDermott
- The Orthopedic Specialty Hospital, 5848 S Fashion Blvd, Murray, UT 84107, USA
| | - Julie M Hughes
- United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA 01760, USA
| | - Stephanie A Baxter
- The Orthopedic Specialty Hospital, 5848 S Fashion Blvd, Murray, UT 84107, USA
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, 420 Delaware St. SE. MMC381, Minneapolis, MN 55455, USA
| | - Moira A Petit
- School of Kinesiology, Laboratory of Musculoskeletal Health, University of Minnesota, 1900 University Ave SE, Minneapolis, MN 55455, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - David J Satin
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Montreal, Quebec, Canada
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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] [What about the content of this article? (0)] [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. Appl Neuropsychol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Matthew Gorman
- a Sports & Orthopedic Specialists , Edina , Minnesota , USA
| | - Suzanne Hecht
- b Department of Family Medicine and Community Health , University of Minnesota , Minneapolis , Minnesota , USA
| | - Andrew Samborski
- c University of Minnesota Medical School , Minneapolis , Minnesota , USA
| | - Scott Lunos
- d Biostatistical Design and Analysis Center, Clinical and Translational Science Institute , Minneapolis , Minnesota , USA
| | - Steven Elias
- e USA Cup Medical Director , Blaine , Minnesota , USA.,f Department of Family Medicine and Community Health and Department of Pediatrics , University of Minnesota , Minneapolis , Minnesota , USA.,g Healthpartners , St. Paul , Minnesota , USA
| | - Steven D Stovitz
- b Department of Family Medicine and Community Health , University of Minnesota , Minneapolis , Minnesota , USA
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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] [What about the content of this article? (0)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- I Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - R J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - M Zhao
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - A Naimi
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - E Verhagen
- Department of Public and Occupational Health, EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - S D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - M J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - T E Hewett
- OSU Sports Health & Performance Institute, Ohio State University, Columbus, Ohio, USA.,Departments of Physiology & Cell Biology, Family Medicine, Orthopaedics and Biomedical Engineering, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
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Bonikowske AR, Carpenter KC, Bandyopadhyay D, Stovitz SD, Pereira M, Lewis BA. The Short-term Effect Of Sit-stand Workstations On Blood Glucose In Obese Women With Impaired Fasting Glucose. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478545.96927.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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