Physiological and Perceived Effects of Forearm or Head Cooling During Simulated Firefighting Activity and Rehabilitation.

CONTEXT:  Cooling devices aim to protect firefighters by attenuating a rise in body temperature. Devices for head cooling (HC) while firefighting and forearm cooling (FC) during rehabilitation (RHB) intervals are commonly marketed, but research regarding their efficacy is limited. OBJECTIVE:  To investigate the physiological and perceived effects of HC and FC during firefighting drills and RHB. DESIGN:  Randomized controlled clinical trial. SETTING:  Firefighter training center. PATIENTS OR OTHER PARTICIPANTS:  Twenty-seven male career firefighters (age = 39 ± 7 years; height = 169 ± 7 cm; weight = 95.4 ± 16.8 kg). INTERVENTION(S):  Firefighters were randomly assigned to 1 condition: HC (n = 9), in which participants completed drills wearing a cold gel pack inside their helmet; FC (n = 8), in which participants sat on a collapsible chair with water-immersion arm troughs during RHB; or control (n = 10), in which participants used no cooling devices. Firefighters completed four 15-minute drills (D1-D4) wearing full bunker gear and breathing apparatus. Participants had a 15-min RHB after D2 (RHB1) and D4 (RHB2). MAIN OUTCOME MEASURE(S):  Change (Δ) in gastrointestinal temperature (T RESULTS:  The T CONCLUSIONS:  The HC did not attenuate rises in physiological or perceptual variables during firefighting drills. The FC effectively reduced

Comprehensive Coach Education Reduces Head Impact Exposure in American Youth Football

BACKGROUND: Despite little evidence that defines a threshold of head impact exposure or that participation in youth sports leads to long-term cognitive impairments, it is prudent to identify methods of reducing the frequency of head impacts. PURPOSE: To compare the mean number of head impacts between youth football players in practice and games between leagues that implemented the Heads Up Football (HUF) educational program and those that did not (NHUF). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: During the 2014 season, head impact exposure was measured using xPatch accelerometers from 70 youth football players aged 8 to 15 years from 5 leagues. Data were collected during both games and practices. The NHUF group comprised 32 players from 8 teams within 3 leagues. The HUF group comprised 38 players from 7 teams within 2 leagues. Independent-sample t tests evaluated differences in head impact exposure across groups (ie, HUF and NHUF). RESULTS: Players (mean ± SD: age, 11.7 ± 1.4 years; height, 152.2 ± 10.5 cm; weight, 51.6 ± 9.6 kg) experienced a total of 7478 impacts over 10g, of which 4250 (56.8%) and 3228 (43.2%) occurred in practices and games, respectively. The majority of impacts occurred within the NHUF group (62.0%), followed by the HUF group (38.0%). With a 10g impact threshold, the mean number of impacts during practice per individual event was lower in the HUF group (mean ± SD, 5.6 ± 2.9) than in the NHUF group (mean ± SD, 8.9 ± 3.1; difference, 3.4; 95% CI, 2.9-3.9). This difference was attenuated when the threshold was changed to 20g but remained significant (difference, 1.0; 95% CI, 0.7-1.3). At both the 10g and 20g impact thresholds, no differences were found in games. CONCLUSION: Players who participated in HUF leagues accumulated fewer head impacts per practice at both the 10g and 20g thresholds. Youth football leagues should consider the HUF educational program, while exploring additional interventions, to help reduce the number of head impacts in players

Exertional Heat Illness Risk Factors and Physiological Responses of Youth Football Players

OBJECTIVE: To determine which intrinsic and extrinsic exertional heat illness (EHI) risk factors exist in youth American football players and observe perceptual and physiological responses of players during events (games and practices). METHODS: Cross-sectional cohort study observing 63 youth football players, varying in position. Independent variables were league (weight-restricted (WR, n = 27) and age-restricted (AR, n = 36)) and event type. Dependent variables were anthropometrics, work-to-rest ratio, and wet bulb globe temperature. Descriptive variables included preparticipation examination and uniform configuration. A subset of 16 players participated in physiological variables (heart rate and gastrointestinal temperature). Data collection occurred on 7 AR and 8 WR nonconsecutive practices and the first 3 games of the season. RESULTS: Mean values for anthropometric variables were higher (p \u3c 0.05) in the AR league than the WR league. Work time (χ (1,111) = 4.232; p = 0.039) and rest time (χ (1,111) = 43.41; p \u3c 0.001) were significantly greater for games, but ratios were significantly higher for practices (χ (1,111) = 40.62; p \u3c 0.001). The majority of events (77%) observed were in black and red flag wet bulb globe temperature risk categories. A total of 57% of the players had a preparticipation examination, and up to 82% of events observed were in full uniforms. Individual gastrointestinal temperature and heart rate responses ranged widely and no players reached critical thresholds. CONCLUSION: Extrinsic (disproportionate work ratios, environmental conditions) and intrinsic (higher body mass index) EHI risk factors exist in youth football. Certain risk factors may be influenced by event and league type. National youth football organizations need to create thorough guidelines that address EHI risk factors for local leagues to adopt

The Prevalence of Secondary School Sport Safety Policies within State Athletic Associations and Legislation

Purpose: The location of secondary school health and safety policies impacts how they are implemented by the sports medicine team and stakeholders. Yet, a comprehensive list of each state’s policy locations has not been established. The purpose of this study was to describe where secondary school health and safety policies were located at the state level within the United States. Method: Emergency related health and safety policies were designated as either being located in the state high school athletics association (SHSAA), state legislation (LEGIS), or in both SHSAA and LEGIS (BOTH). Designation was determined by two researchers who independently reviewed each individual policy. Frequencies were tabulated for the leading causes of catastrophic injury (exertional heat stroke (EHS), traumatic head injuries (THI), sudden cardiac arrest (SCA), and emergency preparedness (EP)) for the distribution of policies emanating from SHSSA, LEGIS or BOTH. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were calculated between the policies categories and location. Results: Most (99.35%) EHS and EP (83.02%) policies were found in SHSAA. Whereas the majority (79.70%) of SCA policies were found in LEGIS. Traumatic head injuries were most frequently observed in SHSAA, however, had the greatest distribution across all three categories (SHSAA=45.31%, LEGIS=25.52%, BOTH = 29.16%). The category that most frequently found policies in BOTH was THI (THI= 29.16%, all others =2.25%; PR=12.96; 95% CI=7.81, 21.53). Conclusions: Emergency related health and safety policies for secondary school sports are commonly found in SHSAA. TBI and SCA are also found in LEGIS. This demonstrates great variability of policy locations

The epidemiology of NCAA men’s lacrosse injuries, 2009/10-2014/15 academic years

BACKGROUND: Participation in lacrosse has grown at the collegiate levels. However, little research has examined the epidemiology of collegiate men's lacrosse injuries. This study describes the epidemiology of injuries in National Collegiate Athletic Association (NCAA) men's lacrosse during the 2009/10-2014/15 academic years. METHODS: Twenty-five men's lacrosse programs provided 63 team-seasons of data for the NCAA Injury Surveillance Program (NCAA-ISP) during the 2009/10-2014/15 academic years. Injuries occurred from participation in an NCAA-sanctioned practice or competition, and required attention from an AT or physician. Injuries were further classified as time loss (TL) injuries if the injury restricted participation for at least 24 h. Injuries were reported through electronic medical record application used by the team medical staff throughout the academic year. Injury rates per 1000 athlete-exposures (AE), injury rate ratios (RR), 95% confidence intervals (CI), and injury proportions were reported. RESULTS: Overall, 1055 men's lacrosse injuries were reported, leading to an injury rate of 5.29/1000AE; 95%CI: 4.98-5.61. The TL injury rate was 2.74/1000AE (95%CI: 2.51-2.96). The overall injury rate was higher in competition than practice (12.35 vs. 3.90/1000AE; RR = 3.16; 95%CI: 2.79-3.58). Most injuries were to the lower extremity (58.3%), particularly the ankle (14.1%) in competition and the upper leg (14.3%) in practice. Sprains and strains were the most common diagnoses in both competition (26.9 and 23.7%, respectively) and practice (20.2% and 27.4%, respectively). Most injuries in competitions and practices were due to player contact (32.8 and 17.5%, respectively) and non-contact (29.6 and 40.0%, respectively). CONCLUSIONS: Our estimated injury rates are lower than those from previous college men's lacrosse research. This may be due to increased injury awareness, advances in injury prevention exercise programs, or rule changes. Still, injury prevention can aim to continue reducing the incidence and severity of injury, particularly those sustained in competitions and to the lower extremity

An evidence-based review of the pathophysiology, treatment, and prevention of exercise-associated muscle cramps

Exercise-associated muscle cramps (EAMCs) are common and frustrating for athletes and the physically active. We critically appraised the EAMC literature to provide evidencebased treatment and prevention recommendations. Although the pathophysiology of EAMCs appears controversial, recent evidence suggests that EAMCs are due to a confluence of unique intrinsic and extrinsic factors rather than a singular cause. The treatment of acute EAMCs continues to include self-applied or clinician-guided gentle static stretching until symptoms abate. Once the painful EAMCs are alleviated, the clinician can continue treatment on the sidelines by focusing on patient-specific risk factors that may have contributed to the onset of EAMCs. For EAMC prevention, clinicians should obtain a thorough medical history and then identify any unique risk factors. Individualizing EAMC prevention strategies will likely be more effective than generalized advice (eg, drink more fluids).https://meridian.allenpress.com/nataam2023Sports Medicin

Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football

BACKGROUND: American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards. PURPOSE: To compare injury rates between youth tackle football players in the AO and AW playing standard conditions. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non-time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only. RESULTS: Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]). CONCLUSION: For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football

Autism Spectrum Disorder Symptoms Among Children Enrolled in the Study to Explore Early Development (SEED)

This study examined the phenotypic profiles of children aged 30–68 months in the Study to Explore Early Development (SEED). Children classified as autism spectrum disorder (ASD), developmental delay (DD) with ASD symptoms, DD without ASD symptoms, and population comparison (POP) differed significantly from each other on cognitive, adaptive, behavioral, and social functioning and the presence of parent-reported conditions. Children with ASD and DD with ASD symptoms had mild to severe ASD risk on several measures compared to children with other DD and POP who had little ASD risk across measures. We conclude that children in SEED have varying degrees of ASD impairment and associated deficits. SEED thus provides a valuable sample to explore ASD phenotypes and inform risk factor analyses

Heat Safety in the Workplace:Modified Delphi Consensus to Establish Strategies and Resources to Protect U.S Workers

The purpose of this consensus document was to develop feasible, evidence‐based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus‐based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best‐practices and protect worker health and productivity

Association and Mutation Analyses of 16p11.2 Autism Candidate Genes

Autism is a complex childhood neurodevelopmental disorder with a strong genetic basis. Microdeletion or duplication of a approximately 500-700-kb genomic rearrangement on 16p11.2 that contains 24 genes represents the second most frequent chromosomal disorder associated with autism. The role of common and rare 16p11.2 sequence variants in autism etiology is unknown.To identify common 16p11.2 variants with a potential role in autism, we performed association studies using existing data generated from three microarray platforms: Affymetrix 5.0 (777 families), Illumina 550 K (943 families), and Affymetrix 500 K (60 families). No common variants were identified that were significantly associated with autism. To look for rare variants, we performed resequencing of coding and promoter regions for eight candidate genes selected based on their known expression patterns and functions. In total, we identified 26 novel variants in autism: 13 exonic (nine non-synonymous, three synonymous, and one untranslated region) and 13 promoter variants. We found a significant association between autism and a coding variant in the seizure-related gene SEZ6L2 (12/1106 autism vs. 3/1161 controls; p = 0.018). Sez6l2 expression in mouse embryos was restricted to the spinal cord and brain. SEZ6L2 expression in human fetal brain was highest in post-mitotic cortical layers, hippocampus, amygdala, and thalamus. Association analysis of SEZ6L2 in an independent sample set failed to replicate our initial findings.We have identified sequence variation in at least one candidate gene in 16p11.2 that may represent a novel genetic risk factor for autism. However, further studies are required to substantiate these preliminary findings