Medical report of the Montreal Olympic Games

Risks, Epidemics, and Prevention Measures of Infectious Diseases in Major Sports Events: Scoping Review

BACKGROUND

Major sports events are the focus of the world. However, the gathering of crowds during these events creates huge risks of infectious diseases transmission, posing a significant public health threat.

OBJECTIVE

The aim of this study was to systematically review the epidemiological characteristics and prevention measures of infectious diseases at major sports events.

METHODS

The procedure of this scoping review followed Arksey and O'Malley's five-step methodological framework. Electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched systematically. The general information (ie, publication year, study type) of each study, sports events' features (ie, date and host location), infectious diseases' epidemiological characteristics (ie, epidemics, risk factors), prevention measures, and surveillance paradigm were extracted, categorized, and summarized.

RESULTS

A total of 24,460 articles were retrieved from the databases and 358 studies were included in the final data synthesis based on selection criteria. A rapid growth of studies was found over recent years. The number of studies investigating epidemics and risk factors for sports events increased from 16/254 (6.3%) before 2000 to 201/254 (79.1%) after 2010. Studies focusing on prevention measures of infectious diseases accounted for 85.0% (238/280) of the articles published after 2010. A variety of infectious diseases have been reported, including respiratory tract infection, gastrointestinal infection, vector-borne infection, blood-borne infection, and water-contact infection. Among them, respiratory tract infections were the most concerning diseases (250/358, 69.8%). Besides some routine prevention measures targeted at risk factors of different diseases, strengthening surveillance was highlighted in the literature. The surveillance system appeared to have gone through three stages of development, including manual archiving, network-based systems, and automated intelligent platforms.

CONCLUSIONS

This critical summary and collation of previous empirical evidence is meaningful to provide references for holding major sports events. It is essential to improve the surveillance techniques for timely detection of the emergence of epidemics and to improve risk perception in future practice.

Fluorescence flow cytometer to determine urine particle reference intervals in doping control samples

BACKGROUND

Urine is still the matrix of choice to fight against doping, because it can be collected non-invasively during anti-doping tests. Most of the World Anti-Doping Agency's accredited laboratories have more than 20 years experience in analyzing this biological fluid and the majority of the compounds listed in the 2010 Prohibited List-International Standard are eliminated through the urinary apparatus. Storing and transporting urine samples for doping analyses does not include a specific protocol to prevent microbial and thermal degradation. The use of a rapid and reliable screening method could enable determine reference intervals for urine specimens in doping control samples and evaluate notably the prevalence of microbial contamination known to be responsible for the degradation of chemical substances in urine.

METHODS

The Sysmex® UF-500i is a recent urine flow cytometer analyzer capable of quantifying BACT and other urinary particles such as RBC, WBC, EC, DEBRIS, CAST, PATH.CAST, YLC, SRC as well as measuring urine conductivity. To determine urine anti-doping reference intervals, 501 samples received in our laboratory over a period of two months were submitted to an immediate examination. All samples were collected and then transported at room temperature. Analysis of variance was performed to test the effects of factors such as gender, test type [in-competition, out-of-competition] and delivery time.

RESULTS

The data obtained showed that most of the urine samples were highly contaminated with bacteria. The other urine particles were also very different according to the factors.

CONCLUSIONS

The Sysmex® UF-500i was capable of providing a snapshot of urine particles present in the samples at the time of the delivery to the laboratory. These particles, BACT in particular, gave a good idea of the possible microbial degradation which had and/or could have occurred in the sample. This information could be used as the first quality control set up in WADA (World Anti-Doping Agency) accredited laboratories to determine if steroid profiles, endogenous and prohibited substances have possibly been altered.

Emergency medical care in the athletes' village: World University Games 1993

OBJECTIVE

Little information exists concerning special medical needs at the athletes' residence (as distinct from the sport venues) at major international sporting events. During the summer of 1993, Buffalo, New York became the first city in the United States to host the World University Games. Approximately 6,000 athletes and accompanying staff from 118 countries attended. This report seeks to characterize emergency medical care use and the degree of language difficulty encountered at the athletes' village medical center (AVMC) set up at the athletes' residence for this event.

METHODS

Demographic data were collected prospectively for each athlete or staff member housed in the athletes' village who presented to AVMC for medical evaluation rather than being cared for by a team physician or at one of the venues. Difficulty in medical treatment secondary to language differences was assessed by the treating physician on a scale of 0-3.

RESULTS

Over the 14 days that the AVMC was in operation, for 24 hours a day, a total of 362 athletes (mean age: 22.9 +/- 2.9 years, 257 males, 105 females) and 149 accompanying staff (mean age: 39.8 +/- 11.6 years, 110 males, 39 females) were treated. More than 90% of the patients were seen between the hours of 0800 and 2400. A broad spectrum of minor medical problems occurred, with musculoskeletal injuries accounting for most of the visits for both athletes (54%) and staff (27%). Nonsteroidal anti-inflammatory agents and oral antibiotics were the most commonly prescribed medications. On-site radiographic facilities were used for 22% of the athletes and 11% of the staff treated. The majority of patients (92% of athletes, 91% of staff) were discharged from the AVMC. Four of the 12 patients that were transferred to a hospital-based emergency department were admitted to the hospital. Language problems, as assessed by the treating physician, were mostly minor; 25% of the patients had accompanying interpreters. One volunteer physician, and two to three nurses adequately staffed each shift.

CONCLUSION

The AVMC provided medical care for a large variety of medical problems that could be treated on-site without transfer to a higher-level facility, thereby providing directed medical care for this special population in a secure environment. Language differences were perceived as a minor problem. This report should be valuable in the planning of medical care at the athletes' residences for similarly large sporting events.

Using regression analysis to predict emergency patient volume at the Indianapolis 500 mile race

BACKGROUND

Emergency physicians often plan and provide on-site medical care for mass gatherings. Most of the mass gathering literature is descriptive. Only a few studies have looked at factors such as crowd size, event characteristics, or weather in predicting numbers and types of patients at mass gatherings.

PURPOSE

We used regression analysis to relate patient volume on Race Day at the Indianapolis Motor Speedway to weather conditions and race characteristics.

METHODS

Race Day weather data for the years 1983 to 1989 were obtained from the National Oceanic and Atmospheric Administration. Data regarding patients treated on 1983 to 1989 Race Days were obtained from the facility hospital (Hannah Emergency Medical Center) data base. Regression analysis was performed using weather factors and race characteristics as independent variables and number of patients seen as the dependent variable. Data from 1990 were used to test the validity of the model.

RESULTS

There was a significant relationship between dew point (which is calculated from temperature and humidity) and patient load (P less than .01). Dew point, however, failed to predict patient load during the 1990 race. No relationships could be established between humidity, sunshine, wind, or race characteristics and number of patients.

CONCLUSION

Although higher dew point was associated with higher patient load during the 1983 to 1989 races, dew point was a poor predictor of patient load during the 1990 race. Regression analysis may be useful in identifying relationships between event characteristics and patient load but is probably inadequate to explain the complexities of crowd behavior and too simplified to use as a prediction tool.

Public health at the 1984 Summer Olympics: the Los Angeles County experience

During the 1984 Summer Olympic Games, the Los Angeles County Department of Health Services used its active disease surveillance system to monitor disease occurrence and other health concerns. Reports were collected by telephone three times a week from 198 participating facilities including hospitals, prepaid health plans, private physicians, and Olympic sites. Background data were obtained two months preceding the Olympic events. Less illness was recorded during the Olympics than during the same period for the three preceding years.

Athletes' Use and Abuse of Drugs

In brief: This article presents a review of the literature on drug misuse by athletes and information from 16 sports and medical organizations whose representatives met in 1985 to discuss the problem. Studies of drug use by athletes are relatively few. Existing data do not show a difference in drug use between athletes and nonathletes, but anabolic steroids probably are used more widely among athletes. Our review disclosed little evidence that drugs can improve an athlete's performance without also posing the threat of serious harm. Major sports organizations have banned the use of anabolic steroids, stimulants, diuretics, analgesics, beta-adrenergic blockers, cocaine, marijuana, and heroin, and some have begun testing athletes. Physicians should assist efforts to prevent the illegal distribution of drugs and should help with existing education and testing programs.