The Polyclinic at the 1996 Atlanta Olympic Village

The Polyclinic, staffed mainly by volunteers, successfully provided primary health care during 16,519 patient encounters, 64% involving athletes. However, the profile of patient needs held some surprises.     

Public health response for the 1996 Olympic Games

Extensive planning and preparation by public health agencies were required for the provision of public health services during the 1996 Centennial Olympic Games, which brought together more than 10000 athletes from 197 countries and more than 2 million visitors. Public health activities included the development and use of an augmented surveillance system to monitor health conditions and detect disease outbreaks; creation and implementation of 6 environmental health regulations; establishment of a central Public Health Command Center and response teams to coordinate response to public health emergencies; planning for potential mass casualties and the provision of emergency medical services; implementation of strategies for the prevention of heat-related illness; and distribution of health promotion and disease prevention information. Public health agencies should take the lead in organizing and implementing a system for preventing and managing public health issues at future large-scale public events such as the Olympics.     

Podiatry in the 1996 Summer Olympic Games

The 1996 Summer Olympic Games in Atlanta, Georgia, were the largest in Olympic history, with 197 countries participating. These Centennial Games also represented podiatry's greatest involvement in the Olympics to date. The author describes the planning, organization, delivery, and outcome of podiatric medical care in an Olympic Games setting and presents data to assist in the future utilization of podiatry in other multiday, multievent sport competitions.     

Medical care delivery at the 1996 Olympic Games. Centers for Disease Control and Prevention Olympics Surveillance Unit

CONTEXT: Mass gatherings like the 1996 Olympic Games require medical services for large populations assembled under unusual circumstances. OBJECTIVE: To examine delivery of medical services and to provide data for planning future events. DESIGN: Observational cohort study, with review of medical records at Olympics medical facilities. SETTING: One large multipurpose clinic and 128 medical aid stations operating at Olympics-sponsored sites in the vicinity of Atlanta, Ga. PARTICIPANTS: A total of 10715 patients, including 1804 athletes, 890 officials, 480 Olympic dignitaries, 3280 volunteers, 3482 spectators, and 779 others who received medical care from a physician at an Olympic medical station. MAIN OUTCOME MEASURES: Number of injuries and cases of heat-related illness among participant categories, medical use rates among participants with official Games credentials, and use rates per 10000 persons attending athletic competitions. RESULTS: Injuries, accounting for 35% of all medical visits, were more common among athletes (51.9% of their visits, P < .001) than among other groups. Injuries accounted for 31.4% of all other groups combined. Spectators and volunteers accounted for most (88.9%, P < .001) of the 1059 visits for heat-related illness. The rates for number of medical encounters treated by a physician were highest for athletes (16.2 per 100 persons, P < .001) and lowest for volunteers (2.0 per 100). Overall physician treatment rate was 4.2 per 10000 in attendance (range, 1.6-30.1 per 10000). A total of 432 patients were transferred to hospitals. CONCLUSIONS: Organizers used these data during the Games to monitor the health of participants and to redirect medical and other resources to areas of increased need. These data should be useful for planning medical services for future mass gatherings.     

Doping control in sports--a perspective from the 1996 Olympic Games

Doping-control (DC) procedures, particularly as used at the 1996 Olympic Games, are described, and the role of pharmacists in DC is discussed. DC procedures must be strict and precisely followed to avoid contamination of samples, the appearance of bias, and breaches in security and confidentiality. The process of selecting athletes for testing can be random, nonrandom, or a combination of the two. Escorts are used to notify athletes of their selection, verify their identity, and accompany them to the DC station. When urine specimens are obtained for DC, the voiding process must be directly observed. The specimen is checked for pH and specific gravity and then processed for shipping to a laboratory to be analyzed for banned substances. Medication histories are also obtained, giving athletes the opportunity to declare any substance that has been taken for legitimate medical purposes. Laboratory analysis involves screening and confirmation phases. During the Atlanta Games, roughly 50 pharmacists participated in the DC program as escorts or technical officers. It is logical to involve pharmacists in DC programs because they can develop and conduct drug-testing protocols; educate athletes, coaches, and trainers about drug use and abuse; and help ensure the safe and effective use of medications. Sophisticated doping-control procedures have been developed for athletic competitions, and pharmacists have much to offer DC programs.     

Asthma in United States Olympic athletes who participated in the 1996 Summer Games

The epidermis has a requirement for fatty acids in order to synthesize cellular membranes and the extracellular lipid lamellar membranes in the stratum corneum. Despite high endogenous production of fatty acids the transport of exogenous essential fatty acids into the epidermis is an absolute requirement. Fatty acid uptake by keratinocytes has been shown to be mediated by a transport system. In this study we determined in murine epidermis and human cultured keratinocytes the expression of three putative fatty acid transport related proteins and fatty acyl CoA synthase, an enzyme that facilitates the uptake of fatty acids by promoting their metabolism. In cultured human keratinocytes, mRNA for fatty acid transport protein (FATP), plasma membrane fatty acid binding protein (FABP-pm), and fatty acyl CoA synthase (FACS) were detectable. Differentiation, induced by high calcium, did not affect FATP mRNA levels, but resulted in an approximately 50% increase in FACS mRNA, while decreasing FABP-pm mRNA by 50%. Fatty acid translocase (FAT) mRNA was not detected in cultured human keratinocytes. In murine epidermis, FATP, FABP-pm, FACS, and FAT mRNA were all present. Barrier disruption by either tape stripping or acetone treatment increased FAT mRNA levels by approximately 2-fold without affecting FATP, FABP-pm, or FACS. Occlusion with an impermeable membrane immediately after barrier disruption completely blocked the increase in FAT mRNA levels, indicating that this increase is related to barrier disruption rather than a nonspecific injury effect. In summary, this study demonstrates that several putative fatty acid transport related proteins as well as fatty acyl CoA synthase are expressed in keratinocytes and epidermis, and that the expression of these proteins may be regulated by differentiation and/ or barrier disruption.     

Mental health services in the public and private sectors

Analysis of data on mental health service providers indicates that in 1971 the private sector accounted for 34% of inpatient days, 86% of outpatient visits, 44% of expenditures by source of funds, and 51% of expenditures by receipt of funds. The author believes that mental health professionals must familiarize themselves with the economic interests influencing national health insurance proposals and with public policy making processes if they are to help preserve appropriate roles for the public and private sectors in mental health service delivery.     

An overview of mental health services for the elderly

Psychiatric distress is substantially prevalent among elderly individuals, particularly in the primary care and institutional settings, where most older persons receive mental health care. Barriers to care from providers include negative attitudes and stigmatization and poor recognition by general health care professionals. When psychiatric disorders are recognized, the intensity and duration of treatment provided is generally below standards for adequacy. Further research can determine the impact of patient, caregiver, and provider factors on treatment provision and on patient adherence to treatment. Assessment of factors influencing the treatment process are needed to ensure that treatments provided in the real world approximate the efficacy established in controlled clinical trials.     

Nurse managed occupational health centers: an overview

1. Nurse managed centers provide clients with direct access to professional nursing care. 2. Lillian Wald, Mary Breckenridge, and Margaret Sanger established nurse managed centers at the beginning of this century. 3. Primary, secondary, and tertiary prevention programs and services are based on the mission, outcomes, staffing, and financing of the occupational health center. 4. Essential parameters for comprehensively evaluating an occupational health nurse managed center include, client outcomes, client satisfaction, and cost-benefit.     

Physicians'' strikes and health services: an ethical perspective

Interferon (IFN) upregulates tumor antigenic expression and enhances tumor uptake of radiolabeled tumor-specific monoclonal antibody (MAb). IFN also increases tumor blood flow. The relationship between these phenomena was investigated. Human melanoma tumors grown in nude mice were used as the experimental tumor model, and 99mTc-MEM136 as an MAb. Tumor blood flow was monitored by ultrasound Color Doppler Imaging (CDI) and Laser Doppler Flowmetry (LDF) techniques. Tumor blood flow increased at 20 min after administration of IFN. Enhancement lasted for about 60 min before the blood flow returned to the original baseline level. Tissue distribution of 99mTc-MEM136 was studied under different experimental schemes. Tumor uptake of 99mTc-MEM136 enhanced significantly only in experimental scheme A (5.5 +/- 0.2% ID/g vs. 3.0 +/- 0.9% ID/g in control group, p = 0.04). In this scheme IFN was given 30 min prior to the administration of 99mTc-MEM136, and the animals were sacrificed 1.5 h later. No upregulation of anti-genic expression was reported at this time. The increased tumor uptake at this early period appeared to be the result of enhanced tumor blood flow.     

Differences between metropolitan and country public hospital allied health services

This paper compares patient and episode characteristics in allied health services delivered in country and metropolitan hospitals. Eight public hospitals (46 allied health services) participated in the study (three country and five metropolitan sites, situated in South Australia, Queensland and Tasmania). Standardised rates of patient throughput were similar for country and metropolitan allied health services, despite smaller numbers of country staff providing services to larger geographical areas. Although the differences were not significant, country patients were generally older and had more chronic conditions than metropolitan patients. Fewer country patients than metropolitan patients were eligible for rebates in the private sector. In addition, fewer alternative services were available in country communities, which heightened the role of the public hospital outpatients services within the community. This paper provides an argument for similar funding arrangements for country and metropolitan ambulatory allied health services.     

Medical care and public health. V. Conclusion

After an incubation period of one to two months rabies presents with non-specific prodromal symptoms and often with paraesthesiae of the bitten area. As in canine rabies there are furious and dumb forms of the disease. In man, furious rabies is characterised by hydrophobia: terror and excitation with spasms of inspiratory muscles, larynx and pharynx precipitated by attempts to drink and by a variety of other stimuli. Hydrophobia may represent an exaggerated respiratory tract irritant reflex with associated arousal potentiated by the selective destruction of brain stem inhibitory systmes. Also typical of furious rabies are intermittent episodes of excitement, hallucinations and maniacal behaviour. Focal neurological abnormalities are surprisingly uncommon. Other signs include hypersalivation, tachycardia and hyperpyrexia. Paralysis and coma supervene after a few days: survival rarely exceeds seven days. Dumb or paralytic rabies is an ascending flaccid paralysis with sphincter involvement and sensory disturbances. Death from respiratory and bulbar paralysis occurs after a longer illness than furious rabies. In a minority of cases hydrophobia develops before the terminal coma. Complications include respiratory arrest, pneumonitis, cardiac arrhythmias and interstitial myocarditis, posterior pituitary disorders, and gastrointestinal bleeding. Differential diagnoses of furious rabies include hysterical pseudo hydrophobia, tetanus, other encephalitides, delirium tremens and various other intoxications. Paralytic rabies may have to be distinguished from postvaccinal encephalomyelitis, poliomyelitis and other causes of Landry-type ascending paralysis. Intensive care has produced some promising results: life-threatening complications can be prevented but there is some evidence that the severity of the encephalitis is the ultimate barrier to survival.     

Maximizing the effectiveness of psychology in public mental health services.

Rather than a preoccupation with diagnosis and pathology, psychologists should direct their attention to the capacity of individuals for adaptation and adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)