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  • 1
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    Clinical and Demographic Factors Associated With COVID-19, Severe COVID-19, and SARS-CoV-2 Infection in Adults : A Secondary Cross-Protocol Analysis of 4 Randomized Clinical Trials
    American Medical Association (AMA) ; 2023
    In:  JAMA Network Open Vol. 6, No. 7 ( 2023-07-13), p. e2323349-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 6, No. 7 ( 2023-07-13), p. e2323349-
    Abstract: Current data identifying COVID-19 risk factors lack standardized outcomes and insufficiently control for confounders. Objective To identify risk factors associated with COVID-19, severe COVID-19, and SARS-CoV-2 infection. Design, Setting, and Participants This secondary cross-protocol analysis included 4 multicenter, international, randomized, blinded, placebo-controlled, COVID-19 vaccine efficacy trials with harmonized protocols established by the COVID-19 Prevention Network. Individual-level data from participants randomized to receive placebo within each trial were combined and analyzed. Enrollment began July 2020 and the last data cutoff was in July 2021. Participants included adults in stable health, at risk for SARS-CoV-2, and assigned to the placebo group within each vaccine trial. Data were analyzed from April 2022 to February 2023. Exposures Comorbid conditions, demographic factors, and SARS-CoV-2 exposure risk at the time of enrollment. Main Outcomes and Measures Coprimary outcomes were COVID-19 and severe COVID-19. Multivariate Cox proportional regression models estimated adjusted hazard ratios (aHRs) and 95% CIs for baseline covariates, accounting for trial, region, and calendar time. Secondary outcomes included severe COVID-19 among people with COVID-19, subclinical SARS-CoV-2 infection, and SARS-CoV-2 infection. Results A total of 57 692 participants (median [range] age, 51 [18-95] years; 11 720 participants [20.3%] aged ≥65 years; 31 058 participants [53.8%] assigned male at birth) were included. The analysis population included 3270 American Indian or Alaska Native participants (5.7%), 7849 Black or African American participants (13.6%), 17 678 Hispanic or Latino participants (30.6%), and 40 745 White participants (70.6%). Annualized incidence was 13.9% (95% CI, 13.3%-14.4%) for COVID-19 and 2.0% (95% CI, 1.8%-2.2%) for severe COVID-19. Factors associated with increased rates of COVID-19 included workplace exposure (high vs low: aHR, 1.35 [95% CI, 1.16-1.58]; medium vs low: aHR, 1.41 [95% CI, 1.21-1.65] ; P   & amp;lt; .001) and living condition risk (very high vs low risk: aHR, 1.41 [95% CI, 1.21-1.66]; medium vs low risk: aHR, 1.19 [95% CI, 1.08-1.32] ; P   & amp;lt; .001). Factors associated with decreased rates of COVID-19 included previous SARS-CoV-2 infection (aHR, 0.13 [95% CI, 0.09-0.19]; P   & amp;lt; .001), age 65 years or older (aHR vs age & amp;lt;65 years, 0.57 [95% CI, 0.50-0.64]; P   & amp;lt; .001) and Black or African American race (aHR vs White race, 0.78 [95% CI, 0.67-0.91]; P  = .002). Factors associated with increased rates of severe COVID-19 included race (American Indian or Alaska Native vs White: aHR, 2.61 [95% CI, 1.85-3.69]; multiracial vs White: aHR, 2.19 [95% CI, 1.50-3.20] ; P   & amp;lt; .001), diabetes (aHR, 1.54 [95% CI, 1.14-2.08]; P  = .005) and at least 2 comorbidities (aHR vs none, 1.39 [95% CI, 1.09-1.76]; P  = .008). In analyses restricted to participants who contracted COVID-19, increased severe COVID-19 rates were associated with age 65 years or older (aHR vs & amp;lt;65 years, 1.75 [95% CI, 1.32-2.31]; P   & amp;lt; .001), race (American Indian or Alaska Native vs White: aHR, 1.98 [95% CI, 1.38-2.83]; Black or African American vs White: aHR, 1.49 [95% CI, 1.03-2.14] ; multiracial: aHR, 1.81 [95% CI, 1.21-2.69]; overall P  = .001), body mass index (aHR per 1-unit increase, 1.03 [95% CI, 1.01-1.04]; P  = .001), and diabetes (aHR, 1.85 [95% CI, 1.37-2.49]; P   & amp;lt; .001). Previous SARS-CoV-2 infection was associated with decreased severe COVID-19 rates (aHR, 0.04 [95% CI, 0.01-0.14]; P   & amp;lt; .001). Conclusions and Relevance In this secondary cross-protocol analysis of 4 randomized clinical trials, exposure and demographic factors had the strongest associations with outcomes; results could inform mitigation strategies for SARS-CoV-2 and viruses with comparable epidemiological characteristics.
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2023.23349
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2931249-8
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  • 2
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    SARS-CoV-2 Viral Load in the Nasopharynx at Time of First Infection Among Unvaccinated Individuals : A Secondary Cross-Protocol Analysis of 4 Randomized Trials
    American Medical Association (AMA) ; 2024
    In:  JAMA Network Open Vol. 7, No. 5 ( 2024-05-23), p. e2412835-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 7, No. 5 ( 2024-05-23), p. e2412835-
    Abstract: SARS-CoV-2 viral load (VL) in the nasopharynx is difficult to quantify and standardize across settings, but it may inform transmission potential and disease severity. Objective To characterize VL at COVID-19 diagnosis among previously uninfected and unvaccinated individuals by evaluating the association of demographic and clinical characteristics, viral variant, and trial with VL, as well as the ability of VL to predict severe disease. Design, Setting, and Participants This secondary cross-protocol analysis used individual-level data from placebo recipients from 4 harmonized, phase 3 COVID-19 vaccine efficacy trials sponsored by Moderna, AstraZeneca, Janssen, and Novavax. Participants were SARS-CoV-2 negative at baseline and acquired COVID-19 during the blinded phase of the trials. The setting included the US, Brazil, South Africa, Colombia, Argentina, Peru, Chile, and Mexico; start dates were July 27, 2020, to December 27, 2020; data cutoff dates were March 26, 2021, to July 30, 2021. Statistical analysis was performed from November 2022 to June 2023. Main Outcomes and Measures Linear regression was used to assess the association of demographic and clinical characteristics, viral variant, and trial with polymerase chain reaction–measured log 10 VL in nasal and/or nasopharyngeal swabs taken at the time of COVID-19 diagnosis. Results Among 1667 participants studied (886 [53.1%] male; 995 [59.7%] enrolled in the US; mean [SD] age, 46.7 [14.7] years; 204 [12.2%] aged 65 years or older; 196 [11.8%] American Indian or Alaska Native, 150 [9%] Black or African American, 1112 [66.7%] White; 762 [45.7%] Hispanic or Latino), median (IQR) log 10 VL at diagnosis was 6.18 (4.66-7.12) log 10 copies/mL. Participant characteristics and viral variant explained only 5.9% of the variability in VL. The independent factor with the highest observed differences was trial: Janssen participants had 0.54 log 10 copies/mL lower mean VL vs Moderna participants (95% CI, 0.20 to 0.87 log 10 copies/mL lower). In the Janssen study, which captured the largest number of COVID-19 events and variants and used the most intensive post-COVID surveillance, neither VL at diagnosis nor averaged over days 1 to 28 post diagnosis was associated with COVID-19 severity. Conclusions and Relevance In this study of placebo recipients from 4 randomized phase 3 trials, high variability was observed in SARS-CoV-2 VL at the time of COVID-19 diagnosis, and only a fraction was explained by individual participant characteristics or viral variant. These results suggest challenges for future studies of interventions seeking to influence VL and elevates the importance of standardized methods for specimen collection and viral load quantitation.
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2024.12835
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2024
    detail.hit.zdb_id: 2931249-8
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  • 3
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    Risk of COVID-19 after natural infection or vaccination
    Elsevier BV ; 2023
    In:  eBioMedicine Vol. 96 ( 2023-10), p. 104799-
    Details
    In: eBioMedicine, Elsevier BV, Vol. 96 ( 2023-10), p. 104799-
    Type of Medium: Online Resource
    ISSN: 2352-3964
    URL: Article
    DOI: 10.1016/j.ebiom.2023.104799
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2799017-5
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  • 4
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    Assessment of Coping Skills in Pediatric Sports Medicine Patients
    SAGE Publications ; 2022
    In:  Orthopaedic Journal of Sports Medicine Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0042-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 10, No. 5_suppl2 ( 2022-05-01), p. 2325967121S0042-
    Abstract: Psychological variables play integral roles in an athlete’s response to injury recovery, and poor mental coping skills have been shown to have a negative impact. The Athletic Coping Skills Inventory-28 has been demonstrated to have predictive value in identifying pediatric patients who may be at risk for a prolonged recovery. Hypothesis/Purpose: The purpose of this study was to investigate variations in coping skills in pediatric sports medicine patients using the Athletic Coping Skills Inventory-28, and to examine correlations with the following variables: age, gender, individual vs. team sports, and time devoted to sport. Methods: This was a cross-sectional, single institution study, that assessed young sports medicine patients, ages 12-18. A one-time, voluntary, anonymous survey was utilized to assess demographics, primary sport, sport participation patterns, and the validated Athletic Coping Skills Inventory-28 (ACSI, range 0-84). Younger adolescents were considered to be ages 11-14 and older adolescents ages 15-18 for data analysis. Statistical analysis included Fischer’s exact tests, t-tests, Pearson correlations, linear regression analysis, and Wilcoxon rank sum tests. Results: Of 430 eligible patients, 334 (mean±sd age 15.0±1.8 years, 64.7% female, 35.3% male) completed questionnaires, for a 78% response rate. The mean ACSI score was 50.2±10.9. No significant differences were observed in overall ACSI scores between genders. ACSI scores were higher in younger adolescents compared to older adolescents (52.4±10.5 vs 48.9±10.9, p 〈 0.010). Team sport athletes reported higher coping skill scores than individual sport athletes (51.2±10.9 vs 47.2±10.8, p 〈 0.001). Multivariable linear regression revealed that younger team sport athletes demonstrated higher coping skill scores compared to older team sport athletes (55.9 vs 49.8, p 〈 0.001). Younger team sport athletes also scored higher than the younger individual sport athletes (55.9 vs 47.6 p=0.002). In addition, playing 〉 16 hours per week of sports adds 6.36 (95% CI: 3.14, 9.57) units to the total ACSI score compared to participants who play 〈 11 hour per week. Conclusion: Athletic coping skills scores did not significantly differ among genders in adolescent athletes. ACSI scores were higher in younger adolescents and athletes playing team sports. Coping skill scores are also positively correlated with time devoted to playing sports.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00428
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 5
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    SPORT SPECIALIZATION, ATHLETIC IDENTITY, AND COPING STRATEGIES IN YOUNG ATHLETES
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 7_suppl3 ( 2021-07-01)
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 7_suppl3 ( 2021-07-01)
    Abstract: Child and adolescent sports participation continues to rise, often with specialization in a single sport at an early age. Psychological associations with sport specialization have been reported, although targeted research is lacking. Hypothesis/Purpose: The purpose of this study was to examine associations between sport specialization, levels of athletic identity, and coping skills among adolescent athletes. Methods: A cross-sectional survey study of sports medicine patients, 12-18 years, was performed. Athletes completed a one-time, voluntary, anonymous survey. Surveys included demographics, sport participation information, Athletic Identity Measurement Scale (AIMS,10-item, range 7-70), Jayanthi Sport Specialization Scale (range 0-6), and Athletic Coping Skills Inventory (ACSI, 7 subscales, range 0-84). Statistical analysis included Fisher’s exact tests, t-tests, Pearson correlations, and linear regression. Results: 334 out of 430 eligible patients completed surveys, with a response rate of 78%. Mean age was 15.0±1.8 years and participants were 64.6% female. 97.7% of participants designated participation in a primary sport, where they spent most of their time. Athletes reported starting this primary sport at a mean age of 7.2±3.7 years. Using the Jayanthi scale, 52.1% of respondents were classified as low specialization (score 0-3) and 47.9% as highly specialized (score 4-6). Sport specialization patterns did not significantly differ by age, sex, or sport. AIMS and Jayanthi scores positively correlated (r=0.39, p 〈 0.0001), and athletes with the highest athletic identities (top 25%) were significantly more specialized than those with the weakest (bottom 25%) athletic identities (4.1 vs 2.5, p 〈 0.001). Regression analysis demonstrated that every 1 point increase in the Jayanthi specialization scale was associated with an AIMS score increase of 2.7 points (p 〈 0.001). The AIMS score also increased 0.83 points for every one month increase in playing their primary sport (p 〈 0.001), and decreased 0.42 points with each year delay in starting their primary sport (p=0.02). Highly specialized athletes had significantly higher overall coping skills scores compared to low specialization athletes (51.6 vs 48.4, p 〈 0.02), particularly on ACSI subscales of Coachability, Concentration, Confidence & Achievement Motivation, and Goal Setting & Mental Preparation (Table 1), however highly specialized athletes reported less Freedom From Worry compared to those with less specialization (5.8 vs 6.7, p=0.02). Conclusion: Athletic identity was higher in athletes who were more specialized and started their primary sport earlier in life. Greater sport specialization may confer some advantages in developing coping strategies in young athletes, however these athletes may be at risk for more worry compared to less specialized athletes. [Table: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967121S00111
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 6
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    Treating low back pain in athletes: a systematic review with meta-analysis
    BMJ ; 2021
    In:  British Journal of Sports Medicine Vol. 55, No. 12 ( 2021-06), p. 656-662
    Details
    In: British Journal of Sports Medicine, BMJ, Vol. 55, No. 12 ( 2021-06), p. 656-662
    Abstract: To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement. Data sources Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS). Results Among 1629 references, 14 randomised controlled trials (RCTs) involving 541 athletes were included. The trials had biases across multiple domains including performance, attrition and reporting. Treatments included exercise, biomechanical modifications and manual therapy. There were no trials evaluating the efficacy of surgery or injections. Exercise was the most frequently investigated treatment; no RTS data were reported for any exercise intervention. There was a reduction in pain and disability reported after all treatments. Conclusions While several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.
    Type of Medium: Online Resource
    ISSN: 0306-3674 , 1473-0480
    URL: Article
    DOI: 10.1136/bjsports-2020-102723
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2003204-3
    detail.hit.zdb_id: 600592-5
    SSG: 31
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  • 7
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    Low energy availability surrogates associated with lower bone mineral density and bone stress injury site
    Wiley ; 2022
    In:  PM&R Vol. 14, No. 5 ( 2022-05), p. 587-596
    Details
    In: PM&R, Wiley, Vol. 14, No. 5 ( 2022-05), p. 587-596
    Abstract: Exercise is an osteogenic stimulus that should increase bone mineral density (BMD) and protect against injury. However, some female athletes have lower BMD and increased bone stress injury (BSI) risk. Impaired bone health seen in athletes may be explained by low energy availability as described by concepts of Relative Energy Deficiency in Sport (RED‐S) and Female Athlete Triad (Triad). Objective To elucidate the relationship between RED‐S/Triad risk factors and BSI to high‐risk (femoral neck, sacrum) and low‐risk (other) bones. Design Cross‐sectional survey and retrospective chart review. Setting Tertiary care academic center. Patients Female athletes aged 15–30 years participating in ≥4 h/week of exercise presenting to sports medicine/orthopedics clinic who had a self‐reported BSI and available dual‐energy x‐ray absorptiometry (DXA) measurement of BMD. Interventions Not applicable. Main Outcome Measurements Location of BSI. Results In 127 athletes, high‐risk BSI was associated with surrogates of low energy availability ( p  = .032) and having a DXA Z‐score  〈  −1 ( p  = .035) but not a current/past history of menstrual dysfunction ( p  = .348). Accumulating RED‐S/Triad risk factors increase the odds of incurring a high‐risk BSI ( p  = .048). Conclusions Adolescent/young female athletes who sustain BSI at high‐risk sites (femoral neck, sacrum) may have underlying risk factors (eg, low energy availability, poor overall bone health) that should prompt further workup and referral to optimize health in these athletes.
    Type of Medium: Online Resource
    ISSN: 1934-1482 , 1934-1563
    URL: Issue
    URL: Article
    DOI: 10.1002/pmrj.v14.5
    DOI: 10.1002/pmrj.12821
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2480906-8
    detail.hit.zdb_id: 2608988-9
    SSG: 31
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  • 8
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    Serum 25-Hydroxyvitamin D is Associated With Bone Microarchitecture and Strength in a Multiracial Cohort of Young Adults
    The Endocrine Society ; 2022
    In:  The Journal of Clinical Endocrinology & Metabolism Vol. 107, No. 9 ( 2022-08-18), p. e3679-e3688
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 107, No. 9 ( 2022-08-18), p. e3679-e3688
    Abstract: To determine whether 25-hydroxyvitamin D (25-OH D) levels are associated with bone outcomes in a multiracial cohort of young adults. Methods This cross-sectional study included 165 participants (83 men, 82 women, 18-30 years of age) who self-identified as Asian, Black, or White. We measured bone microarchitecture and strength of the distal radius and tibia using high-resolution peripheral quantitative computed tomography. We used linear regression to estimate the association between 25-OH D (ng/mL) and bone measurements, adjusting for race, sex, age, weight, height, calcium intake, physical activity, and season. Results A total of 43.6% of participants were 25-OH D deficient ( & lt;20 ng/mL) with greater prevalence in Asian (38.9%) and Black (43.1%) compared with White (18.0%) participants (P  & lt; 0.001). At the distal radius, 25-OH D was positively associated with cortical area, trabecular density, cortical thickness, cortical porosity, and failure load (P  & lt; 0.05 for all). At the distal tibia, higher 25-OH D was associated with higher cortical area, trabecular density, trabecular number, failure load, and lower trabecular separation and cortical density (P  & lt; 0.05 for all). After multivariable adjustment, those with 25-OH D deficiency had generally worse bone microarchitecture than those with 25-OH D sufficiency. Black individuals had largely more favorable bone outcomes than Asian and White individuals, despite higher prevalence of 25-OH D deficiency. Conclusions We found a high prevalence of 25-OH D deficiency in a multiracial cohort of young adults. Lower 25-OH D was associated with worse bone outcomes at the distal radius and tibia at the time of peak bone mass, warranting further attention to vitamin D status in young adults.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/clinem/dgac388
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2022
    detail.hit.zdb_id: 2026217-6
    detail.hit.zdb_id: 3029-6
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  • 9
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    Impact Mechanics in Female Runners with Single and Multiple Stress Fractures Following Fatigue : 2309 May 31 10:20 AM - 10:30 AM
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Medicine & Science in Sports & Exercise Vol. 51, No. 6S ( 2019-6), p. 635-635
    Details
    In: Medicine & Science in Sports & Exercise, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 6S ( 2019-6), p. 635-635
    Type of Medium: Online Resource
    ISSN: 1530-0315 , 0195-9131
    URL: Article
    DOI: 10.1249/01.mss.0000562397.30456.54
    RVK:
    ZX 1000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 603994-7
    detail.hit.zdb_id: 2031167-9
    SSG: 31
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  • 10
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    Boston Marathon Prospective Study: Medical And Performance Outcomes Associated With Indicators Of Low Energy Availability : 991
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Medicine & Science in Sports & Exercise Vol. 55, No. 9S ( 2023-9), p. 333-333
    Details
    In: Medicine & Science in Sports & Exercise, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. 9S ( 2023-9), p. 333-333
    Type of Medium: Online Resource
    ISSN: 1530-0315 , 0195-9131
    URL: Article
    DOI: 10.1249/01.mss.0000982876.19546.68
    RVK:
    ZX 1000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 603994-7
    detail.hit.zdb_id: 2031167-9
    SSG: 31
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