ABSTRACT
Exertional heat stroke (EHS) is a common clinical problem for both athletes and warriors; however, evidence-based guidance for return-to-play/duty (RTP/RTD) decisions is limited. Heat tolerance testing (HTT) has been proposed as a potential tool that, when combined with appropriate clinical information, may assist in RTP/RTD decisions. However, currently, no standard of care is available for performing HTT. The Israeli Defense Forces (IDF) HTT protocol, which was developed over decades of careful research, has proven useful for IDF warriors and is utilized by other militaries to assist in RTD decisions. The present case studies are used to discuss the efficacy of the IDF HTT in determining RTD for two warriors who experienced EHS. Strengths and limitations of the IDF HTT, along with current and potential roles in clinical decision-making and in future thermoregulation research, are discussed.
Subject(s)
Exercise Test/standards , Heat Stroke/diagnosis , Heat Stroke/physiopathology , Military Medicine/standards , Military Personnel , Physical Exertion/physiology , Adolescent , Body Temperature Regulation/physiology , Exercise Test/methods , Heat Stroke/prevention & control , Humans , Israel , Male , Military Medicine/methods , United States , Young AdultABSTRACT
OBJECTIVES: Dehydroepiandrosterone sulfate (DHEAS) declines with age and low endogenous DHEAS concentrations have been associated with obesity. In addition, DHEAS has been studied for its role in mood and wellbeing. However, limited data are available on salivary DHEAS concentrations in African Americans. Thus, we examined age-related changes in morning salivary DHEAS and the association between DHEAS and obesity risk factors among African Americans. DESIGN: Salivary DHEAS samples (n=170) were obtained from men and women divided into three age groups: 18 to 30 (young), 31 to 45 (middle) and 46 to 60 (older) years. Anthropometric, blood glucose, high sensitivity c-reactive protein (hsCRP), and blood pressure measures were obtained. Participants completed the Center for Epidemiologic Studies Depression (CESD), Beck Depression Inventory (BDI), Daily Hassles Scale (DHS), Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) scales to assess depression, daily hassles, stress and quality of sleep, respectively. RESULTS: Mean salivary DHEAS concentrations decreased significantly with increasing age: mean values were 25.8 +/- 2.4, 21.9 +/- 1.9, and 14.4 +/- .9 nmol/L for young, middle, and older groups, respectively. Like DHEAS, PSQI, DHS, CESD, MAP, WC, BMI, systolic and diastolic BP and fasting blood glucose values differed significantly in the older compared to the young and middle groups. Women had significantly lower salivary DHEAS than men (P< or =.05). CONCLUSION: The age-related decline in salivary DHEAS in African Americans is associated with cardiovascular risk factors, sleep quality, hassles and mood. Whether supplementing DHEAS levels in aging African Americans will improve health remains to be determined.
Subject(s)
Black or African American , Dehydroepiandrosterone Sulfate/metabolism , Saliva/metabolism , Adolescent , Adult , Affect , Age Factors , Blood Glucose/analysis , Blood Pressure/physiology , C-Reactive Protein/analysis , Depression/ethnology , Depression/physiopathology , Female , Health Status , Humans , Male , Middle Aged , Sleep/physiology , Stress, Psychological/physiopathology , Young AdultABSTRACT
Although progress has been made to understand the association between physiological and lifestyle behaviors with regard to obesity, ethnic differences in markers of obesity and pathways towards obesity remain somewhat unexplained. However, obesity remains a serious growing concern. This paper highlights ethnic differences in African Americans and Caucasians that may contribute to the higher prevalence of obesity among African Americans. Understanding ethnic differences in metabolic syndrome criteria, functioning of the hypothalamic pituitary adrenal axis, variations in glucocorticoid sensitivity and insulin resistance, and physical activity and cardiovascular fitness levels may help to inform practical clinical and public health interventions and reduce obesity disparities.
ABSTRACT
OBJECTIVES: African Americans (AA) experience a high mortality from cardiovascular disease (CVD), even without an increase in the prevalence of the metabolic syndrome (MetS). The potential role of sleep impairment in this phenomenon has not been studied. The current study examined the relationship between self-reported sleep and MetS components among AAs. Sleep variables included total sleep quality and specific symptoms: loud snoring, difficulty breathing, and sleep duration. DESIGN: Anthropometric (BMI, BP, waist circumference, body fat percent) and biologic (fasting glucose, triglycerides, total cholesterol, and HDL) measures were obtained from 248 community-recruited AA (63% female; mean age 44 years). The Pittsburgh Sleep Quality Index (PSQI), a 19-item scale with a total sleep quality score and 7 subscales, was used to assess self-reported sleep quality. Analyses were controlled for age and sex. RESULTS: PSQI total sleep quality predicted neither presence of MetS (Beta=.04, P=.29) nor individual CVD variables. However, symptomatic snoring corresponded with MetS (Beta=.38, SE=.12, P<.001; OR: 2.57), as well as with fasting glucose, BMI, body fat percentage, and waist circumference. CONCLUSIONS: Among AA, overall sleep quality as self-reported may not contribute to MetS, but symptomatic snoring appears to be important. Further work in this area should focus on sleep at the symptomatic level, and include racial and sex variables, as well as physiologic and etiologic mechanisms.
