Staff turnover, compromised skin integrity in residents, a suboptimal infection control program, and lack of awareness of infections likely contributed to continued GAS transmission. In widespread, prolonged GAS outbreaks in skilled nursing facilities, facility-wide chemoprophylaxis may be necessary to prevent sustained person-to-person transmission.

Adults have been increasingly motivated to compete in recreational endurance sports events. Amateurs may lack a complete understanding of recommended strategies for handling heat and humidity, making heat-related illnesses increasingly possible. This is compounded by global climate change and increasing average surface and air temperatures, especially in urban areas of industrialized nations in Europe and North America that have hosted most events to date. We conducted an on-line, secure survey at the 2nd Annual ING Georgia Marathon and Half-Marathon in Atlanta, Georgia, in 2008. We included previously validated questions on participant socio-demographics, training locations, and knowledge and awareness of heat-related illnesses. Participants were aware of heat illnesses, and of heat stroke as a serious form of heat stress. However, the majority, across age and gender, did not understand the potential severity of heat stroke. Furthermore, 1-in-5 participants did not understand the concept of heat stress as a form of heat-related illness, and how heat stress may result from buildup of muscle-generated heat in the body. Adult recreational endurance athletes are another susceptible, vulnerable population sub-group for applied research and public health educational interventions, especially in urban areas of industrialized nations in Europe and North America.

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Objective: Limited research exists on recreationallevel competitors regarding asthma and/or comorbidity. The present purpose was to conduct a study in conjunction with the 2008 ING Georgia Marathon and Half-Marathon in Atlanta. Methods: The authors conducted an online secure survey in winter 2008 using PsychData, using previously validated questions from other research and national surveys. Data were summarized from participating recreational athletes on sociodemographic attributes; training locations; participant and family member diagnosis of asthma; and participant knowledge and awareness of signs, symptoms, and management. Results: There were 1151 participants (99.4%) who provided informed consent and then answered the survey (more than 10% of initially registered athletes); 7 athletes (0.6%) did not consent. There were complete data for 1138 participants (98%). Most participants were women (56.2%), white (88.2%), and of a relatively higher socioeconomic status than the general population. Most participants (96.2%) were running either a full marathon (29.8%) or half-marathon (66.4%), as opposed to walking or participating as a wheelchair athlete. About 1 in 8 participants (12.1%) reported physiciandiagnosed asthma. Clinically, whereas 84.6% correctly knew that an asthma action plan can prevent hospitalizations due to asthma, only 18% reported that they had such a plan. Moreover, only 24.8% had ever been asked to demonstrate medication use (controller and/or rescue inhaler), and only 2 people performed daily peak flow measurements. Conclusions: In a study of physically active white adults of higher socioeconomic status, 12.1% reported asthma. As such, this study identified the need for potential improvements in asthma management via written asthma action plans and demonstration of peak flow monitoring and medication use.