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Buchholtz K, Lambert M, Corten L, Burgess TL. Incidence of Injuries, Illness and Related Risk Factors in Cross-Country Marathon Mountain Biking Events: A Systematic Search and Review. SPORTS MEDICINE - OPEN 2021; 7:68. [PMID: 34564784 PMCID: PMC8464637 DOI: 10.1186/s40798-021-00357-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
Background Cycling is a popular global sport and method of transportation and a significant contributor to admissions to hospital emergency units following an injury. Mountain biking events present additional challenges with remote venues and isolated courses, for which on-site medical care is often provided, for both injury and illness occurring during races. National health data may not represent these unique events, and specific data on incidence of injury and illness in mountain biking events are essential. Therefore, the aim of this study was to review the available injury and illness literature, reporting methods and risk factors in cross-country mountain biking. Methods Search engines PubMed, Scopus, CINAHL (EBSCOhost), Scopus, PEDro and the Cochrane Library were systematically searched, and a grey literature search was performed. Narrative analyses of the types, severity and area of injuries and illness type and severity were performed as pooling of data was impossible due to insufficient high-quality studies with the same injury and illness definitions. Results Seven studies comprising 28,021 participants were included for analysis. Four to 71% of participants sustained an injury in a cross-country mountain bike event. Injuries to the skin were the most common, followed by bony injuries and concussion. Five to 47% of cyclists reported the onset of gastrointestinal symptoms post-event. The prevalence of illness during events ranged from 0.5 to 23.0%. Conclusion The injury and illness definitions were varied and prevented clear comparisons between studies. Injury and illness present a concern in cross-country marathon mountain biking and should be investigated further to provide the true burden of these during race events. Registration: This protocol has been registered with PROSPERO International prospective register of systematic reviews (No: CRD42019134586).
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Sharp A, Smout E, Byrne L, Greenwood R, Abdoollah R, Hutchinson C, Jenkins C, Arunachalam N, Padfield S, Hughes G, Gent M. An outbreak of Shiga toxin-producing Escherichia coli O157:H7 linked to a mud-based obstacle course, England, August 2018. Zoonoses Public Health 2020; 67:467-473. [PMID: 32564515 DOI: 10.1111/zph.12744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 04/11/2020] [Accepted: 05/19/2020] [Indexed: 01/01/2023]
Abstract
In August 2018, Public Health England (PHE) was made aware of five probable cases of Shiga toxin-producing Escherichia coli (STEC) O157:H7 among individuals reporting participation in a mud-based obstacle race. An additional four cases, identified via routine whole-genome sequencing, were subsequently linked to the same event. Two of the nine cases were due to secondary household transmission. Despite an agreement between the event organizers and the local authority, to ensure that all livestock were removed from the site 28 days before the event, sheep were observed grazing on some of the routes taken by the runners 2 days prior to the race taking place. A retrospective review of incidents reported to PHE between 2015 and 2018 identified 41 cases of gastroenteritis associated with muddy assault course events. Of these, 25 cases were due to infection with STEC O157:H7, of which all but one were associated with outbreaks. Due to the environment in which such events take place, it is impossible to entirely remove the risk of exposure to potentially pathogenic zoonoses. However, race organizers should ensure that livestock are removed from the course 28 days before the event. They should also ensure that participants are made aware of the risk of contracting gastrointestinal disease from the environment, and to stress the importance of hand hygiene post-event and the risk of secondary transmission, particularly to children who are at risk of developing haemolytic uraemic syndrome.
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Affiliation(s)
- Alexander Sharp
- Yorkshire and the Humber Health Protection Team, Public Health England, Leeds, UK
| | - Elizabeth Smout
- Field Service, National Infection Service, Public Health England, London, UK.,UK Field Epidemiology Training Programme, Public Health England, London, UK
| | - Lisa Byrne
- Gastrointestinal Infections Department, National Infection Service, Public Health England, London, UK
| | - Rebecca Greenwood
- Yorkshire and the Humber Health Protection Team, Public Health England, Leeds, UK
| | | | - Charlotte Hutchinson
- Yorkshire and the Humber Health Protection Team, Public Health England, Leeds, UK
| | - Claire Jenkins
- Gastrointestinal Bacteria Reference Unit, National Infection Service, Public Health England, London, UK
| | - Nachi Arunachalam
- Yorkshire and the Humber Health Protection Team, Public Health England, Leeds, UK
| | - Simon Padfield
- Yorkshire and the Humber Health Protection Team, Public Health England, Leeds, UK
| | - Gareth Hughes
- Field Service, National Infection Service, Public Health England, London, UK
| | - Mike Gent
- Yorkshire and the Humber Health Protection Team, Public Health England, Leeds, UK
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Martínez-Sanz JM, Fernández Nuñez A, Sospedra I, Martínez-Rodríguez A, Domínguez R, González-Jurado JA, Sánchez-Oliver AJ. Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114082. [PMID: 32521666 PMCID: PMC7312487 DOI: 10.3390/ijerph17114082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 01/16/2023]
Abstract
During the last few years, the numbers of competitors in endurance and ultra-endurance sports modalities have increased significantly. This type of competition is an extreme challenge for athletes. Therefore, they have an increased the risk of developing medical and nutritional problems. The aim of the work is to estimate the incidence of nutrition-related adverse outcomes in endurance and ultra-endurance sports, considering the variables that influence them. A critical review was carried out based on the PubMed database, by means of a search strategy based on keywords separated by Boolean connectors. For all the results obtained in a period from 2008 to 2019, a series of inclusion/exclusion criteria was applied to select only the studies that fitted the objective of the present study. Results and discussion: Of the 871 publications identified, 33 met the inclusion criteria. The adverse outcomes found included exercise-associated hyponatremia (EAH), heat stroke by exertion (EHS), gastrointestinal (GI) problems, dehydration, and hypothermia; the provision of misinformation to athletes about nutrient intake and hydration during competition was identified as the main cause. Conclusions: The main adverse outcomes in endurance and ultra-endurance sports modalities are EAH, GI inconveniences, and EHS. These problems can affect the performance and health status of the athlete during and post-competition. Several nutritional guidelines have been suggested that can prevent these adverse outcomes, and it is essential to individualize and adjust the nutritional intake and hydration status according to the characteristics of each competition.
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Affiliation(s)
- José Miguel Martínez-Sanz
- Departamento de Enfermería, Grupo de Investigación en Alimentación y Nutrición (ALINUT), Facultad de Ciencias de la Salud, Universidad de Alicante, 03690 Alicante, Spain; (J.M.M.-S.); (I.S.)
| | - Ana Fernández Nuñez
- Facultad de Ciencias de la Salud, Universidad de Alicante, 03690 Alicante, Spain;
| | - Isabel Sospedra
- Departamento de Enfermería, Grupo de Investigación en Alimentación y Nutrición (ALINUT), Facultad de Ciencias de la Salud, Universidad de Alicante, 03690 Alicante, Spain; (J.M.M.-S.); (I.S.)
| | - Alejandro Martínez-Rodríguez
- Analytical Chemistry, Nutrition and Food Sciences Department, Sciences Faculty, University of Alicante, 03690 Alicante, Spain;
| | - Raúl Domínguez
- Facultad de Ciencias de la Salud de la Universidad Isabel I, 09003 Burgos, Spain;
| | - José Antonio González-Jurado
- Facultad del Deporte, Universidad Pablo Olavide de Sevilla, 41013 Sevilla, Spain
- Correspondence: ; Tel.: +34-651-517-571
| | - Antonio J. Sánchez-Oliver
- Departamento de Motricidad Humana y Rendimiento Deportivo, Universidad de Sevilla, 41004 Sevilla, Spain;
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den Boogert EM, Oorsprong DM, Fanoy EB, Leenders ACAP, Tostmann A, van Dam ASG. Risk factors for developing acute gastrointestinal, skin or respiratory infections following obstacle and mud run participation, the Netherlands, 2017. Euro Surveill 2019; 24:1900088. [PMID: 31595875 PMCID: PMC6784448 DOI: 10.2807/1560-7917.es.2019.24.40.1900088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundIn the Netherlands, obstacle, mud and survival runs are increasingly popular. Although outbreaks of gastroenteritis have been reported following these events, associated health risks have not been systematically assessed.AimTo investigate the incidence of acute gastrointestinal infections (AGI), skin infections (SI) and respiratory infections (RI) among obstacle run participants, as well as risk factors.MethodsBetween April and October 2017, we conducted a retrospective cohort study among 2,900 participants of 17 obstacle runs in the Netherlands. Demographic, symptomatic and behavioural data were collected from participants via an online questionnaire 1 week after participation in an obstacle run. Stool specimens were obtained from respondents for microbiological tests. Adjusted relative risks (aRR) and 95% confidence intervals (CI) using multilevel binomial regression analysis were calculated.ResultsOf 2,646 respondents (median age: 33 years; 53% male), 76 had AGI after the obstacle run; ingesting mud was associated with AGI (aRR: 1.7; 95% CI: 1.2-4.9) and 38 respondents had AGI during or in the week before the obstacle run. Overall, 103 respondents reported SI and 163 RI. Rinsing off in a hot tub was associated with SI (aRR: 2.2; 95% CI: 1.7-2.8). Of 111 stool specimens, 13 tested positive for six different pathogens. No clusters were found.ConclusionThe reported incidence of AGI, SI and RI was low. Risk of these infections could be decreased by informing participants on preventive measures, e.g. showering vs rinsing in the hot tub, avoiding ingesting mud and not participating with symptoms of AGI.
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Affiliation(s)
- Elisabeth M den Boogert
- Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, ‘s-Hertogenbosch, the Netherlands
| | - Danielle M Oorsprong
- Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, ‘s-Hertogenbosch, the Netherlands
| | - Ewout B Fanoy
- Department of Infectious Disease Control, Public Health Service Rotterdam-Rijnmond, Rotterdam, the Netherlands,Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Alexander CAP Leenders
- Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Alma Tostmann
- Academic Public Health Initiative AMPHI, Department of Primary and Community Care, Radboud Centre for Infectious Diseases, Nijmegen, the Netherlands
| | - Adriana SG van Dam
- Department of Infectious Disease Control, Municipal Health Service Hart voor Brabant, ‘s-Hertogenbosch, the Netherlands
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DeNizio JE, Hewitt DA. Infection from Outdoor Sporting Events-More Risk than We Think? SPORTS MEDICINE - OPEN 2019; 5:37. [PMID: 31414195 PMCID: PMC6694362 DOI: 10.1186/s40798-019-0208-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/28/2019] [Indexed: 12/19/2022]
Abstract
Competitive sports that involve extensive contact with mud are commonly held events and growing in popularity. However, the natural environment contributes to infection risks, and these events have been implicated in multiple infectious disease outbreaks. Soils and mud contain rich microbial communities and can include pathogens (including viruses, bacteria, and parasites), thereby offering risk of infection; there is also a risk of disease due to shedding, by participants, of pathogens directly into the environment. These disease risks are ubiquitous and are present in the most developed countries, as well as elsewhere. Prevention of the further spread of mud sport-related infections through secondary infections to non-participant community members is of critical importance. We recommend shifts in practice and policy, such as site condition monitoring, improved messaging with regards to infections risk, and implementation of pre- and post-event wash stations to reduce these risks.
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Affiliation(s)
- Jamie E DeNizio
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - David A Hewitt
- Department of Biology, University of Pennsylvania, 102 Leidy Laboratories, 433 S University Ave, Philadelphia, PA, 19104, USA.
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Six C, Aboukais S, Giron S, D'Oliveira JC, Peloux-Petiot F, Franke F, Terrien H, Dassonville F, Deniau J, Ambert-Balay K, Chesnot T, Ruimy R, Pélandakis M, Basset P, Munoz Rivero M, Malfait P. Outbreak of diarrhoeal illness in participants in an obstacle adventure race, Alpes-Maritimes, France, June 2015. ACTA ACUST UNITED AC 2017; 21:30253. [PMID: 27311488 DOI: 10.2807/1560-7917.es.2016.21.23.30253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/17/2016] [Indexed: 11/20/2022]
Abstract
An acute gastroenteritis (AG) outbreak occurred among participants in an obstacle race in France in the summer of 2015. An investigation in two phases was conducted to identify the source of infection and document the extent of the outbreak. First, a message on a social media website asked racers to report any symptoms by email to the Regional Health Agency of Provence-Alpes-Côte d'Azur. Second, a retrospective cross-sectional study was conducted through an interactive questionnaire for all participants, followed by an analytical study of potential risks factors. Of 8,229 persons registered, 1,264 adults reported AG resolved within 48 hours. Of adults who reported AG, 866 met the case definition. Age group, departure time and ingestion of mud were associated with AG. Twenty stool specimens tested negative for bacteria. All four stool samples tested for viruses were positive for norovirus genogroup I and genotype 2. No indicator bacteria for faecal contamination were found in drinking water but muddy water of ponds tested positive. The outbreak was possibly caused by human-to-human transmission of a norovirus introduced by one or more persons and transmitted through contaminated mud. Risks related to similar races should be assessed and recommendations be proposed to raise awareness among health authorities and organisers.
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Affiliation(s)
- Caroline Six
- Santé publique France, French national public health agency, Regional unit (Cire Provence-Alpes-Côte d'Azur and Corsica), Marseilles, France
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Kaakoush NO, Castaño-Rodríguez N, Mitchell HM, Man SM. Global Epidemiology of Campylobacter Infection. Clin Microbiol Rev 2015; 28:687-720. [PMID: 26062576 PMCID: PMC4462680 DOI: 10.1128/cmr.00006-15] [Citation(s) in RCA: 887] [Impact Index Per Article: 98.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Campylobacter jejuni infection is one of the most widespread infectious diseases of the last century. The incidence and prevalence of campylobacteriosis have increased in both developed and developing countries over the last 10 years. The dramatic increase in North America, Europe, and Australia is alarming, and data from parts of Africa, Asia, and the Middle East indicate that campylobacteriosis is endemic in these areas, especially in children. In addition to C. jejuni, there is increasing recognition of the clinical importance of emerging Campylobacter species, including Campylobacter concisus and Campylobacter ureolyticus. Poultry is a major reservoir and source of transmission of campylobacteriosis to humans. Other risk factors include consumption of animal products and water, contact with animals, and international travel. Strategic implementation of multifaceted biocontrol measures to reduce the transmission of this group of pathogens is paramount for public health. Overall, campylobacteriosis is still one of the most important infectious diseases that is likely to challenge global health in the years to come. This review provides a comprehensive overview of the global epidemiology, transmission, and clinical relevance of Campylobacter infection.
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Affiliation(s)
- Nadeem O Kaakoush
- School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - Natalia Castaño-Rodríguez
- School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - Hazel M Mitchell
- School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, NSW, Australia
| | - Si Ming Man
- School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, NSW, Australia Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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van de Venter EC, Oliver I, Stuart JM. Timeliness of epidemiological outbreak investigations in peer-reviewed European publications, January 2003 to August 2013. Euro Surveill 2015; 20. [DOI: 10.2807/1560-7917.es2015.20.6.21035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- E C van de Venter
- Public Health England, Bristol, United Kingdom
- South West Public Health Training Programme, Health Education South West, Bristol, United Kingdom
| | - I Oliver
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Field Epidemiology Service, Public Health England, Bristol, United Kingdom
| | - J M Stuart
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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9
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Gastrointestinal disease outbreaks in cycling events: are preventive measures effective? Epidemiol Infect 2012; 141:517-23. [PMID: 22591923 DOI: 10.1017/s0950268812000817] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In 2009, following a bike race, a gastrointestinal illness outbreak affected many participants. A cohort study showed an attack rate of 16·3% with the main risk factor being mud splashes to the face. Considering these findings, in 2010 recommendations to participants in the bike race were issued and environmental control measures were implemented. In 2010, a retrospective cohort study using web-based questionnaires was conducted to measure the use of preventive measures and to assess risk factors associated with gastrointestinal illness. A 69% response rate was achieved and 11721 records analysed, with 572 (attack rate 4·9%) matching the case definition, i.e. participants reporting diarrhoea within 10 days of race. There was a clear increase in the use of mudguards (96·7% reported access to/receiving information on preventive measures) and a significant decrease in gastrointestinal illness. This may indicate that the measures have been effective and should be considered, both in terms of environmental control measures as well as individual measures.
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