Football is the world’s most-watched and played sport. Even though sports psychiatry is steadily gaining importance, the stigma on mental illness in sports, especially football, and the limited number of articles on this topic means there is a pressing need for more study in this area. This narrative review begins to fill this gap. This review summarises the work on addictive disorders in sports, with a close focus on football, as well as mentioning some initiatives that are advancing our understanding of how mental illnesses in sports can be addressed.

This view also contributes to understanding the reasons behind mental illness and sports, and raises awareness.

This review was conducted by searching for the keywords ‘addiction’ and ‘football’ on three different database search engines, namely, PubMed, Cochrane Library, and Medline. We found 26 articles based on this literature search with these keywords from 2005 to 2020. After data extraction, we cited 10 of them considering the specificity of addiction disorders in the football industry. 16 additional articles found by backwards citation chaining are also included in this review.

The articles reviewed here investigate addictive disorders within the football sector by looking at the incidence of particular addictive disorders, their underlying reasons and their consequences. This piece concludes by showing the need for more research and new initiatives regarding addictive disorders within the target group of footballers.

A holistic, multidisciplinary and biopsychosocial approach is essential to provide long term solutions considering different factors contributing to addictive disorders in the football sector.

No significant relationships.

This paper provides a large-scale, per Major League Baseball (MLB) game analysis of foul ball (FB) injury data and provides estimates of injury frequency and severity.

This study’s goal was to quantify and describe the rate and type of FB injuries at MLB games.

This was a retrospective review of medical care reports for patients evaluated by on-site health care providers (HCPs) over a non-contiguous 11-year period (2005-2016). Data were obtained using Freedom of Information Act (FOIA) requests.

Data were received from three US-based MLB stadiums.

The review reported 0.42-0.55 FB injuries per game that were serious enough to warrant presentation at a first aid center. This translated to a patients per 10,000 fans rate (PPTT) of 0.13-0.23. The transport to hospital rate (TTHR) was 0.02-0.39. Frequently, FB injuries required analgesics but were overwhelmingly minor and occurred less often than non-FB traumatic injuries (5.2% versus 42%-49%). However, FB injured fans were more likely to need higher levels of care and transport to hospital (TH) as compared to people suffering other traumatic injuries at the ballpark. Contusions or head injuries were common. Finally, FB injured fans were often hit in the abdomen, upper extremity, face, or head. It was found that FB injuries appeared to increase with time, and this increase in injuries aligns with the sudden increase in popularity of smartphones in the United States.

These data suggest that in roughly every two or three MLB games, a foul ball causes a serious enough injury that a fan seeks medical attention. This rate is high enough to warrant attention, but is comparable in frequency to other diagnostic categories. Assessing the risk to fans from FBs remains difficult, but with access to uniform data, researchers could answer persistent questions that would lead to actionable changes and help guide public policy towards safer stadiums.

The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is commonly used to assist with post-concussion return-to-play decisions for athletes. Additional investigation is needed to determine whether embedded indicators used to determine the validity of scores are influenced by the presence of neurodevelopmental disorders (NDs).

This study examined standard and novel ImPACT validity indicators in a large sample of high school athletes (n = 33,772) with or without self-reported ND.

Overall, 7.1% of athletes’ baselines were judged invalid based on standard ImPACT validity criteria. When analyzed by group (healthy, ND), there were significantly more invalid ImPACT baselines for athletes with an ND diagnosis or special education history (between 9.7% and 54.3% for standard and novel embedded validity criteria) when compared to athletes without NDs. ND history was a significant predictor of invalid baseline performance above and beyond other demographic characteristics (i.e., age, sex, and sport), although it accounted for only a small percentage of variance. Multivariate base rates are presented stratified for age, sex, and ND.

These data provide evidence of higher than normal rates of invalid baselines in athletes who report ND (based on both the standard and novel embedded validity indicators). Although ND accounted for a small percentage of variance in the prediction of invalid performance, negative consequences (e.g., extended time out of sports) of incorrect decision-making should be considered for those with neurodevelopmental conditions. Also, reasons for the overall increase noted here, such as decreased motivation, “sandbagging”, or disability-related cognitive deficit, require additional investigation.

Large-scale mass-sporting events are increasingly requiring greater prehospital event planning and preparation to address inherent event-associated medical conditions in addition to incidents that may be unexpected. The Bank of America Chicago Marathon (Chicago, Illinois USA) is one of the largest marathons in the world, and with the improvement of technology, the use of historical patient and event data, in conjunction with environmental conditions, can provide organizers and public safety officials a way to plan based on injury patterns and patient demands for care by predicting the placement and timing of needed medical support and resources.

During large-scale events, disaster planning and preparedness between event organizers, Emergency Medical Services (EMS), and local, state, and federal agencies is critical to ensure participant and public safety.

This study looked at the Bank of America Chicago Marathon, a significant endurance event, and took a unique approach of reviewing digital runner data retrospectively over a five-year period to establish patterns of medical demand geographically, temporally, and by the presenting diagnoses. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, coordination, and communication to ensure a safe and secure event.

The Chicago Marathon is one of the largest marathons in the world, and this study identified an equal number of participants requiring care on-course and at the finish line. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. As technology has evolved, the use, analysis, and implementation of historical digital data with various environmental conditions can provide organizers and public safety officials a map to plan injury patterns and patient demands by predicting the placement and timing of needed medical support, personnel, and resources.

There have been recent advances in our appreciation of the functional complementarity of the upper and lower airways. The unified airway begins at the nose: rather than acting merely as a conduit for air to the lungs, the nose and nasal cavity perform an important role in filtering, humidification and immune surveillance.

The physiological and pathological responses of the nasal cavity to exercise and regular training are examined in this narrative review, with specific reference to the relation of nasal health to quality of life, lower airway health and upper respiratory tract infections. Relevant literature is examined and placed in clinical context.

There is considerable published evidence to support nasal dysfunction associated with exercise, and a link to lower airway dysfunction. Evidence also supports the role of upper and lower airway dysfunction in the development of upper respiratory tract infection symptoms.

Nasal dysfunction in exercise may be a source of considerable morbidity to the regular exerciser, and further research into exercise-induced rhinitis is recommended.

Despite the events that occurred at the 2013 Boston Marathon (Boston, Massachusetts USA), there are currently no evidence-based guidelines or published data regarding medical and disaster preparedness of marathon races in the United States.

To determine the current state of medical disaster preparedness of marathons in the US and to identify potential areas for improvement.

A cross-sectional, questionnaire-based study was conducted from January through May of 2014. The questionnaire was distributed to race directors of US road and trail marathons, as identified by a comprehensive internet database.

One hundred twenty-three questionnaires were available for analysis (19% usable response rate). Marathon races from all major regions of the US were represented. Runner medical information was not listed on race bibs in 53% of races. Only 45% of races held group training and planning sessions prior to race day. Automated external defibrillators (AEDs) were immediately available on 50% of courses, and medications such as albuterol (30%), oxygen (33%), and IV fluids (34%) were available less frequently. Regarding medical emergencies, 55% of races did not have protocols for the assessment of dehydration, asthma, chest pain, syncope, or exercise-induced cramping. With regard to disaster preparedness, 50% of races did not have protocols for the management of disasters, and 21% did not provide security personnel at start/finish lines, aid stations, road crossings, and drop bag locations.

Areas for improvement in the preparedness of US marathons were identified, such as including printed medical information on race bibs, increasing pre-race training and planning sessions for volunteers, ensuring the immediate availability of certain emergency equipment and medications, and developing written protocols for specific emergencies and disasters.

GlickJRixeJASpurkelandNBradyJSilvisMOlympiaRP. Medical and Disaster Preparedness of US Marathons. Prehosp Disaster Med. 2015;30(4):1–7.

A modified Medical Resource Model to predict the medical resources required at mass gatherings based on the risk profile of events has been developed. This study was undertaken to validate this tool using data from events held in both a developed and a developing country.

A retrospective study was conducted utilizing prospectively gathered data from individual events at Old Trafford Stadium in Manchester, United Kingdom, and Ellis Park Stadium, Johannesburg, South Africa. Both stadia are similar in design and spectator capacity. Data for Professional Football as well as Rugby League and Rugby Union (respectively) matches were used for the study. The medical resources predicted for the events were determined by entering the risk profile of each of the events into the Medical Resource Model. A recently developed South African tool was used to predetermine medical staffing for mass gatherings. For the study, the medical resources actually required to deal with the patient load for events within the control sample from the two stadia were compared with the number of needed resources predicted by the Medical Resource Model when that tool was applied retrospectively to the study events. The comparison was used to determine if the newly developed tool was either over- or under-predicting the resource requirements.

In the case of Ellis Park, the model under-predicted the basic life support (BLS) requirement for 1.5% of the events in the data set. Mean over-prediction was 209.1 minutes for BLS availability. Old Trafford displayed no events for which the Medical Resource Model would have under-predicted. The mean over-prediction of BLS availability for Old Trafford was 671.6 minutes. The intermediate life support (ILS) requirement for Ellis Park was under-predicted for seven of the total 66 events (10.6% of the events), all of which had one factor in common, that being relatively low spectator attendance numbers. Modelling for ILS at Old Trafford did not under-predict for any events. The ILS requirements showed a mean over-prediction of 161.4 minutes ILS availability for Ellis Park compared with 425.2 minutes for Old Trafford. Of the events held at Ellis Park, the Medical Resource Model under-predicted the ambulance requirement in 4.5% of the events. For Old Trafford events, the under-prediction was higher: 7.5% of cases.

The medical resources that are deployed at a mass gathering should best match the requirement for patient care at a particular event. An important consideration for any model is that it does not continually under-predict the resources required in relation to the actual requirement. With the exception of a specific subset of events at Ellis Park, the rate of under-prediction for this model was acceptable.

SmithWP, TuffinH, StrattonSJ, WallisLA. Validation of a Modified Medical Resource Model for Mass Gatherings. Prehosp Disaster Med.2013;28(1):1-7.

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.

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.

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.

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.