Analysis of doping control test results in individual and team sports from 2003 to 2015.

Background Determining the prevalence of doping in sport might be useful for anti-doping authorities to gauge the effectiveness of anti-doping policies implemented to prevent positive attitudes toward doping. Using questionnaires and personal interviews, previous investigations have found that the prevalence of doping might be different among different sports disciplines; however, there is no sport-specific information about the proportion of adverse and atypical findings in samples used for doping control. The aim of the present investigation was to assess the differences in the frequency of adverse analytical and atypical findings among sports using the data made available by the World Anti-Doping Agency. Method The data included in this investigation were gathered from the Testing Figures Reports made available annually from 2003 to 2015 by WADA. These Testing Figures Reports include information about the number of samples analyzed, the number of adverse and atypical findings reported, and the most commonly found drugs in the urine and blood samples analyzed. A total of 1,347,213 samples were analyzed from the individual sports selected for this investigation, and 698,371 samples were analyzed for disciplines catalogued as team sports. Results In individual sports, the highest proportions of adverse and atypical findings (AAF) were 3.3% ± 1.0% in cycling, 3.0% ± 0.6% in weightlifting and 2.9% ± 0.6% in boxing. In team sports, the highest proportions of AAF were 2.2% ± 0.5% in ice hockey, 2.0% ± 0.5% in rugby and 2.0% ± 0.5% in basketball. Gymnastics and skating had the lowest proportions ≤ 1.0%) for individual sports, while field hockey, volleyball and football had the lowest proportions for team sports (<1.5%). Conclusion As suggested by the analysis, the incidence of AAF was not uniform across all sports disciplines, with the different proportions pointing to an uneven use of banned substances depending on the sport. This information might be useful for increasing the strength and efficacy of anti-doping policies in those sports with the highest prevalence in the use of banned substances.pre-print1193 K

Sport-Specific Use of Doping Substances: Analysis of World Anti-Doping Agency Doping Control Tests between 2014 and 2017.

Background: In recent years, there has been a solid effort across all sports organizations to reduce the prevalence and incidence of doping in sport. However, the efficacy of current strategies to fight against doping might be improved by using anti-doping polices tailored to the features of doping in each sport. Objectives: The aim of this investigation was to analyze the substances more commonly found in doping control tests in individual and team sports. Material and Methods: The publicly accessible Testing Figures Reports made available by the World Anti-Doping Agency, were analyzed from 2014 to 2017. Results: The most commonly detected groups of banned substances were anabolic agents and stimulants but the distribution of adverse findings per drug class was very different depending on the sports discipline. Weightlifting, athletics, rugby, hockey and volleyball presented abnormally high proportions of anabolic agents (p = 2.8 × 10−11). Cycling, athletics and rugby presented atypically elevated proportions of peptide hormones and growth factors (p = 1.4 × 10−1). Diuretics and masking agents were more commonly found in boxing, wrestling, taekwondo, judo, shooting, and gymnastics than in other sports (p = 4.0 × 10−68). Cycling, rowing, aquatics, tennis, gymnastics and ice hockey presented abnormally high proportions of stimulants (p = 1.8 × 10−5). Conclusions: These results indicate that the groups of banned substances more commonly detected in anti-doping control tests were different depending on the sports discipline. These data suggest the prohibited substances used as doping agents might be substantially different depending on the type of sport and thus, sports-specific anti-doping policies should be implemented to enhance the efficacy of anti-doping testing.pre-print523 K

Validación de una encuesta para determinar la prevalencia en el uso de suplementos en deportistas de élite españoles.

Introducción: el uso de suplementos deportivos es una estrategia generalizada entre los deportistas de alto rendimiento. Sin embargo, no existe ningún cuestionario validado en castellano para determinar la prevalencia en el uso de suplementos deportivos en deportistas. Objetivo: el objetivo de esta investigación fue validar un cuestionario en castellano para estudiar la prevalencia del uso de suplementos deportivos. Material y métodos: en una primera fase, el cuestionario fue diseñado para recabar información sobre la frecuencia en el uso de cinco categorías de suplementos (estimulantes, potenciadores del rendimiento, suplementos para control de peso, “recuperadores” y medicamentos). Posteriormente, el contenido del cuestionario fue validado por un grupo de seis expertos que valoraron la pertinencia y claridad de cada pregunta del cuestionario en escalas de 1-10 puntos. La versión final del cuestionario fue completada en dos ocasiones separadas por un mes (test-retest) por un grupo de 39 atletas de élite, con el objetivo de verificar la reproducibilidad en las respuestas a este cuestionario. Resultados: la versión final del cuestionario, obtenida tras la validación de contenido, tiene 81 preguntas que recaban información sociodemográfica y sobre motivos, frecuencia y condiciones de compra de suplementos deportivos. En el test-retest se comprobó una alta congruencia en todas las preguntas del cuestionario, sin diferencia estadística en ninguna de las respuestas en el test-retest. Conclusión: el cuestionario derivado de este estudio cumple con los parámetros de validez y fiabilidad necesarios para la obtención de información vinculada al tipo y frecuencia en el uso de suplementos deportivos.post-print673 K

Prevalence and patterns of dietary supplement use in elite Spanish athletes.

Background: Dietary supplementation is a common strategy to achieve a specific health status or performance benefit. Several investigations have focused on the prevalence of dietary supplement use by athletes. However, information on how athletes manage the use and purchase of dietary supplements is scarce. Methods: Five hundred and twenty-seven high-performance athletes (346 males and 181 females), participating in individual and team sports, completed a validated questionnaire about use and purchase patterns of dietary supplements. The dietary supplements were categorized according to the International Olympic Committee (IOC) consensus. Results: Sixty four percent of the athletes (n = 337) used dietary supplements (median = 3; range 1 to 12). Age, sex, type of sport, level of competition, and professionalism influenced the prevalence of dietary supplement use (all p < 0.05). The most prevalent dietary supplement consumed was proteins (41%; n = 137), followed by amino acids/BCAA-based supplements (37%; n = 124). Additionally, as per group of supplements according to IOC consensus, 18% of the supplements were rated as having a low level of scientific evidence (e.g., glutamine, HMB, L-carnitine, etc). Most athletes (45%, n = 152) purchased dietary supplements in a store and 24% (n = 81) obtained them from a sponsor. Most athletes also (42%, n = 141) reported a self-organization of supplementation and did not consult with any professional. Last, 81% (n = 273) of athletes consuming supplements did not know any platform to check supplement safety/quality. For those who do not use dietary supplements (36% of the total sample, n = 190), most reported that they do not consider supplements necessary (72%, n = 137). Conclusion: Dietary supplementation appears to be widely used in sport with a considerable proportion of athletes consuming supplements with low level of scientific evidence. Additionally, athletes seem to rely on inadequate sources of information and may be largely unaware of sources to detect supplement contamination.post-print795 K

Gender Differences in Prevalence and Patterns of Dietary Supplement Use in Elite Athletes.

Purpose: Dietary supplement use by athletes has been the topic of previous research; however, the lack of homogeneity among published studies makes it difficult to analyze the differences, if any, in the patterns of use between male and female athletes. The aim of this study was to determine gender differences in the patterns of dietary supplement use by elite athletes. Methods: A total of 504 elite athletes (329 males and 175 females) participating in individual and team sports completed a validated questionnaire on dietary supplement use during the preceding season. The dietary supplements were categorized according to the latest IOC consensus statement. Results: A higher proportion of male versus female athletes (65.3 versus 56.5%, p < .05) consumed dietary supplements. Both male and female athletes reported a similar mean consumption of dietary supplements (3.2 ± 2.1 versus 3.4 ± 2.3 supplements/season, respectively; p = .45). Protein supplements were the most commonly consumed supplements in male athletes (49.8%) and their prevalence was higher than in female athletes (29.3%, p < .01). In females, multivitamins (39.4%) and branched-chain amino acids (39.4%) were the most commonly consumed supplements and iron supplementation was more prevalent than in males (22.2% versus 10.2%, p = .01). A higher proportion of male athletes relied on themselves to plan dietary supplements use (48.0%), while female appeared to rely more on doctors (34.0%, p < .01). Conclusion: In summary, male athletes had a slightly higher prevalence in the use of supplements than their female counterparts, specifically regarding protein supplements, and were more involved in the self-prescription of supplements.pre-print1459 K

Outcomes of adverse analytical findings in individual and team sports.

The aim of this investigation was to describe the outcomes of the adverse analytical findings in different Olympic sports. The data included were gathered from the World Anti-Doping Agency Anti-doping Rule Violations Reports (2013–2017). Weightlifting (78.1 ± 9.4%) wrestling (73.2 ± 18.5%) and volleyball (68.3 ± 18.7%) were the sports with the highest proportion of cases that ended in an antidoping sanction. Gymnastics (45.1 ± 10.1%), triathlon (32.6 ± 11.9%) and shooting (29.9 ± 14.1%) were the sports with a higher frequency of cases that were not sanctioned due to medical reasons. Gymnastics (22.4 ± 18.4%), boxing (23.2 ± 16.0%) and taekwondo (17.3.1 ± 16.4%) presented the highest proportion of cases that are still pending resolution. The proportion of cases that ended in no sanction was higher in fencing (26.2 ± 22.7%), skating (23.6 ± 35.1%) and tennis (18.6 ± 26.5%). These results indicate that the sanctions derived from antidoping rule violations were not uniform in all sports disciplines.pre-print365 K

EN-DALBACEN 2.0 Cohort: real-life study of dalbavancin as sequential/consolidation therapy in patients with infective endocarditis due to Gram-positive cocci

Objectives: Infective endocarditis (IE) has high mortality and morbidity and requires long hospital stays to deliver the antibiotic treatment recommended in clinical practice guidelines. We aimed to analyse the health outcomes of the use of dalbavancin (DBV) in the consolidation treatment of IEs caused by Gram-positive cocci and to perform a pharmacoeconomic study. Materials and methods: This observational, retrospective, Spanish multicentre study in patients with IE who received DBV as part of antibiotic treatment in consolidation phase were followed for at least 12 months. The study was approved by the Provincial Committee of the coordinating centre. Results: The study included 124 subjects, 70.2% male, with a mean age of 67.4 years and median Charlson index of 4 (interquartile range: 2.5-6). Criteria for definite IE were met by 91.1%. Coagulase-negative staphylococci (38.8%), Staphylococcus aureus (22.6%), Enterococcus faecalis (19.4%), and Streptococcus Spp. (9.7%) were isolated more frequently, all susceptible to vancomycin. Before DVB administration, 91.2% had undergone surgery; 60.5% had received a second regimen for 24.5 d (16.6-56); and 20.2% had received a third regimen for 14.5 d (12-19.5). DBV was administered to facilitate discharge in 95.2% of cases. At 12 months, the effectiveness was of 95.9%, and there was 0.8% loss to follow-up, 0.8% IE-related death, and 3.2% relapse. Adverse events were recorded in 3.2%. The hospital stay was reduced by 14 d, and there was a mean savings of 5548.57 €/patient vs. conventional treatments. Conclusion: DBV is highly effective, safe, and cost-effective as consolidation therapy in patients with IE by Gram-positive cocci, with few adverse events

El fenómeno del dopaje desde la perspectiva de las ciencias sociales. V.2

El volumen recoge una selección de las comunicaciones presentadas al 5º Congreso Internacional "Deporte, Dopaje y Sociedad", organizado conjuntamente por la Universidad Politécnica de Madrid y por la Agencia Española de Protección de la Salud en el Deporte (AEPSAD)

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries