So from the medical and therapy team, I'm going to discuss a few pertinent things with you today.

Firstly,
Preventing mosquito-borne illness.

A few facts from the nutrition front.

Reiterate Laura's message about communication of illness and injury for prevention of time out from training and or competition.

I promise that it won't take long and that I'll use plenty of pictures and you can be out for coffee asap.

It may seem premature but given the recent hype about certain mosquito-borne illnesses, I thought it was appropriate to mention mosquitos now.

I make no apologies for talking about this now so that you can be prepared and know the risks and ways to reduce your risk of being bitten and catching a mosquito-borne illness.

What I have to say should be interesting for staff as well as athletes and if you have any questions afterwards then please come and ask.

Prevention of mosquito bites in Brazil

You may by now have heard of Dengue Fever and the Zika virus, which are viral infections transmitted by mosquitoes in Brazil, in and around Rio and Belo.

The advice to avoid Zika is the same as for Dengue. All athletes should take adequate precautions to avoid being bitten by mosquitoes.


Prevention is by avoiding mosquito bites especially during the daylight. Some mosquito species bite during daylight hours and some are more active from dusk to dawn.

Dengue
In most people there are no symptoms.

When symptoms occur, there may be high fever, a severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, abdominal pain and poor appetite. The high temperature can persist for 5-6 days; around day 3-4 a skin rash may develop. Most infections are self-limiting with rapid recovery occurring 3-4 days after onset of the rash.

Symptoms of Zika infection
 Symptoms appear a few days after being bitten by an infected mosquito. The incubation varies and can be as long as 12 days.
 Zika virus usually causes mild self-limiting illness similar to ‘flu’
 Commonest symptoms are mild fever and rash.
 Other symptoms include conjunctivitis, muscle and joint pain, and fatigue.
 The symptoms usually last 2 to 7 days.
 These symptoms can be linked with other infections and medical advice should be
sought at the earliest opportunity
Treatment
 Some people may not be aware that they have had Zika and get better without complication.
 There is currently no specific treatment and no vaccine is available.
 Diagnosis is normally made on the basis of appropriate symptoms during or after
travel to an affected area. Mosquito bites may or may not be present.
 A blood test may be available which can confirm infection by the virus and if
appropriate should be arranged by your GP.

Use insect repellents containing 25-50% DEET or 20% Picaridin to exposed skin (but not to the eyes, mouth, or open wounds) and clothing.

Follow any additional instructions on insect repellent bottle labels

Insect repellents

· N-diethylmetatoluamide (DEET) based repellents are the most effective but come in several concentrations. Concentrations of 20% offer protection for 1-3 hours, and higher concentrations provide longer-lasting protection. As the duration of protection does not increase at concentrations higher than 50%, there is no need to use repellents with concentrations greater than this.

Apply every 3 – 6hrs (lower concentration repellents need to be reapplied more frequently)

Remember sweating may remove the repellent so apply more often if needed

· Repellents should be reapplied at regular intervals, after swimming and in hot, humid conditions when they may be removed by perspiration.

Apply repellent after you have applied any sunscreen

· Since DEET can reduce the efficacy of sunscreen, 30-50 SPF sunscreen should be applied for adequate sun protection.
· When both sunscreen and DEET are needed, DEET should be applied after sunscreen.
· Care should be taken to ensure that repellents are not ingested, and that they do not come into contact with the eyes or mouth.
· Do not apply to cuts, abrasions or irritated skin.
· Use only on exposed areas of skin or natural fibres on clothing.
· Remove with soap and water when the repellent is no longer needed.
· Sunscreen that is combined with repellent should usually be avoided.
· Picaridin (Autan®) and lemon eucalyptus extract or PMD (Mosiguard®) are available for those who prefer not to use DEET-based products. These repellents have compared favourably with DEET. Picaridin should be used in concentrations of approximately 20%.

Measures that CANNOT be recommended for repelling insects

• Citronella oil-based repellents (these have very short durations of action)
• Citrosa plant (geranium)
• Garlic: fresh or capsules
• Vitamin B12 complex
• Yeast extract spread
• Electronic (ultrasonic) buzzer devices
• Vitamin B1 tablets
• Tea tree oil

Wear loose fitting long sleeved garments and long trousers, during the daytime when the aedes mosquito is most active.

It is also advisable to wear loose-fitting clothes with long trousers and long sleeves in the evenings.

For additional protection, apply permethrin-containing compounds to clothing and shoes.

Clothing can be treated with an insecticide (e.g. permethrin), which kills insects on contact. Permethrin is available in formulations designed to be sprayed on to clothing. Insect repellents such as DEET can also be applied to natural fibres such as cotton trousers and shirts. However, as this repellent can destroy artificial fibres or plastic, the instructions on the pack should be followed.

Avoid sleeping with the window open unless there is a screen.

Mosquitos are attracted by several factors, including heat, odours and movement. Athletes should wear protective clothing and insect repellents and use plug insecticides to avoid being bitten. Air conditioning reduces likelihood of mosquito bites by reducing night time temperature. Ceiling fans reduce mosquito nuisance. Anti-histamines and lotions can help to manage insect bites if they are causing irritation.

Athletes with a high fever or other worrying symptoms should seek prompt medical advice.

Pregnancy and Zika
The link between Zika and abnormal smallness of the head (microcephaly) has been suggested but not proven. The following precautions are currently advised by UK public health agencies for anyone travelling to affected areas:
 Women who are pregnant or plan to become pregnant are strongly urged to seek pre-travel advice from their healthcare provider (GP or Midwife). This is to help them understand the risk and make an informed decision. Pregnant women should consider postponing travel to areas with Zika virus outbreaks.
 Additional advice may be sought from a Team Doctor or Institute of Sport Doctor.
 All athletes are advised to take careful precautions against mosquito bites
 Female athletes should consider effective contraception to avoid pregnancy
before, during and for at least 28 days after travel to an affected area. This can be discussed with a Team Doctor, Institute of Sport Doctor, GP or Family Planning Clinic.
 If a female partner is pregnant or considering pregnancy, their male partner who has travelled to an affected area should consider using condoms to avoid infecting their partner for 28 days in conjunction with effective contraception. If their male partner has clinical symptoms or laboratory proven Zika infection, this should be continued for 6 months.
It is strongly advised that any athlete travelling to an affected area should discuss appropriate and effective contraceptive measures with their Team Doctor, Institute of Sport Doctor, GP or Family Planning Clinic.
Resources
Public Health England https://www.gov.uk/government/organisations/public-health-england
During Travel

After Travel
Those with fever or other worrying symptoms after travel should seek prompt medical help. Insect bites can sometimes get infected; become swollen, painful and red with pus where the bite occurred. Athletes should contact their doctor if they are concerned about symptoms; antibiotics may be required.

Further information
http://www.nhs.uk/Conditions/dengue/Pages/Introduction.aspx

http://www.insidethegames.biz/articles/1032964/rio-de-janeiro-aiming-to-cur...

This slide is really about fuelling your physical capability as well as your mental recovery.

As your brain takes in new information through training and the competition season, millions of neurons are firing, burning energy and leading to fatigue and exhaustion.

Make sure that you give your mind time to breathe at regular intervals when necessary as mental recovery this can be pivotal to your progress on the Road to Rio.

This, as well as your nutrition or energy intake, is an important part of your recovery from strenuous physical activity and can help to prevent musculoskeletal injury as well as illness from overload of your immune system.

NUTRITION
1. Nutrition services (1-1’s, body comp assessments, supplementation advice and performance strategies) are available to any athlete who is funded on the World Class Performance Programme

2. Nutrition consultations will be carried out in Lboro or can be arranged over Skype for non-local athletes

3. Athletes are responsible for carrying out their own supplementation strategies on competition day – this includes bringing their own shakers and preparing their own protein shakes etc.

4. As with previous competitions, if an athlete would like to have a recovery drink waiting in the mixed zone with the doctor after the race, the drink must be prepared and given to the doc in advance of the event. We're going to make it a policy that your recovery drink is your responsibility to make up and hand to the doc - just like at the airport when they ask you if you packed your own bags, no-one else is responsible for mixing your recovery drinks.

I tend to see you when times are tough - when things are going or have gone wrong.

It's very difficult to help when I get to see you too late. And I wish that you'd come to see me when things started to go wrong - perhaps before you'd even noticed.

I want you to anticipate problems by looking out for EWSs of illness or injury so you notice things early.

If you treat adversity with the right preparation - you give yourself the opportunity to better deal with it earlier and when the situation is increasingly under pressure.

Focus on what you can control.

There are so many things that you can't control - but this is something that you can! Let us know about anything, even if you're not sure - it's better to ask and plan.

In his book, The Obstacle is the Way, Ryan Holiday says that "Overcoming obstacles is a discipline of 3 critical steps: Perception, Action and Will".

Remember that the greatest athletes are those who are prepared, not those who take a chance.

Ryan Holiday goes on to say that

"The only guarantee, ever, is that things will go wrong."

...

...and

"The more you accomplish, the more things will stand in your way."

But if you anticipate problems...

...with anticipation, we have time to help you raise defences and put in interventions like starting treatment for an upper respiratory tract infection or cold, a UTI, or prevention of muscular strain injuries or preventing a shoulder problem from getting out of control.

And from what I see of you all every week, every time you reach a hurdle and say I can't do it, you do do it and you build resistance and resilience. Passing each obstacle just says that you're worthy of more. So there are likely to be things that get in the way over the coming months.

And in the same book he says,

...Shared purpose gives us strength.


So remember that the medical team is here for you. To help you get your medals. To help you win.