Performance-enhancing drugs, supplements and the athlete’s heart

The use of performance-enhancing drugs is an unfortunatereality of contemporary sport. It would be a mistake tobelieve that this is a phenomenon found only in elite sport.Athletes at all levels and young adults may be tempted toaccentuate performance or physique with prohibited drugsor products marketed as supplements. No defined populationsof users ingesting known quantities of known substances are generally available for study. Many of these products have been associated with adverse health effects; cardiac structure and function are known to be affected by many of the products commonly abused. Changes to the lipoprotein profile, propensity for coagulation, coronary circulation, and ventricular function may accompany the use of many performance-enhancing compounds and methods. Anabolic steroids, other peptide hormones, stimulants, erythropoietin and blood doping, have all been associated with significant cardiovascular consequences. So-called nutritional supplements aggressively marketed to the athletically inclined, are available over the Internet and typically totally unregulated in the country of their origin. Clinicians should be aware of the problems that such drug use can engender, and be sensitive to the possibilities of such abuse in caring for athletes and young patients, particularly in those presenting with unusual or unanticipated cardiovascular signs and symptoms

Smoking cessation counselling training in the pre-clerkship curriculum of Canadian medical schools: A national survey

Background: Cigarette use is Canada’s leading cause of preventable disease, disability, and death. The Medical Council of Canada requires that physicians be able to address tobacco-use, however smoking cessation counselling (SCC) training remains largely neglected in the pre-clerkship curricula of many Canadian medical schools.Methods: Between July and October of 2015, Canada’s 17 medical schools were invited to participate in an administrative survey: The Canadian Medical School Assessment of Smoking Cessation Counselling in the Pre-Clerkship Curriculum. Each was asked to comment on the presence of 28 tobacco-related topics in their curricula, including: time devoted to source material; year(s) of training during which medical students were exposed to related content; methods of teaching and examination; and, the attitudes, policies, and barriers relevant to the presence of smoking cessation counselling (SCC) training in the curriculum.A second short survey: Assessing Medical Students Attitudes toward Smoking Cessation Education was distributed to 100 University of Ottawa medical students to assess comfort level and perceived confidence toward addressing smoking cessation with patients.Results: Eleven of 17 medical schools completed the administrative survey. The results demonstrated substantial deficits and inconsistencies in the delivery of SCC training in the pre-clerkship curricula of Canada’s medical schools.  The short survey revealed perceived discomfort regarding smoking cessation discussion, consistent with the potential curriculum deficits suggested in the larger national survey.Conclusion: The results of both surveys suggest an unfortunate oversight given the devastating impact of tobacco-related diseases. Institutional commitment and enhanced inter-university collaboration could facilitate the development of a national undergraduate medical education program to enhance the delivery of SCC training within the pre-clerkship curricula of Canadian medical schools

Students working against tobacco: A novel educational program to improve Canadian medical students’ tobacco counselling skills

Background: Medical professionals should be appropriately trained in the field of smoking cessation counseling and be familiar with related tobacco-control issues. Sadly, Canadian medical students receive little education regarding smoking cessation.Methods: University of Ottawa medical students created Students Working Against Tobacco (SWAT), a program that provides its members with tobacco education and opportunities to discuss tobacco use, smoking prevention and cessation with elementary-school students. Surveys assessing student knowledge and confidence in addressing tobacco issues were administered to the participating students at the start of the program and following their delivery of a school presentation.Results: Students initially lacked knowledge, skills and experience in addressing tobacco issues and discussing smoking prevention and cessation counselling. Following their involvement in the SWAT program, students’ smoking cessation counselling knowledge and skills improved, and they expressed confidence in becoming more engaged in this important preventive health issue.Conclusion: Until smoking cessation is incorporated into undergraduate medical education programs, gaps will remain in the preparation of tomorrow's physicians regarding the provision of effective smoking cessation counselling and their broader understanding of this important health issue. Currently, there are constraints limiting the number of medical undergraduates that SWAT is able to involve and influence

Parallels, prescience and the past: analogical reasoning and contemporary international politics

Analogical reasoning has held a perpetual appeal to policymakers who have often drafted in historical metaphor as a mode of informing decision-making. However, this article contends that since the beginning of the ‘War on Terror’ we have arguably seen the rise of a more potent form of analogy, namely ones that are selected because they fulfil an ideological function. Analogical reasoning as a tool of rational decision-making has increasingly become replaced by analogical reasoning as a tool of trenchant ideologically-informed policy justification. This article addresses three key areas which map out the importance of analogical reasoning to an understanding of developments in contemporary international politics: the relationship between history and politics, in intellectual and policy terms; a critical assessment of the appeal that analogical reasoning holds for policymakers; and the development of a rationale for a more effective use of history in international public policymaking

Economic evaluation of a hospital-initiated intervention for smokers with chronic disease, in Ontario, Canada

Introduction Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. Results From the hospital payer’s perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of$C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. Discussion The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking.This project was supported by a Contribution Agreement between the University of Ottawa Heart Institute and the Ontario Ministry of Health and Long Term Care. All authors declare independence from the funder. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

International Olympic Committee consensus statement on pain management in elite athletes

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The adverse effects of elite competition on health and well-being

Proceedings of the 1st International Meeting of the congress on nutrition and athletic performance, Edmonton, Alberta, Canada, August 8-11, 2001 - Communication lors du congrès 'Nutrition et performance sportive', Edmonton, 8-11 aout 1551