Hydration and Performance in Young Triathletes During a Competition in Tropical Climate.

PURPOSE: We examined fluid intake, the relation between body mass (BM) loss and performance, and core temperature in young triathletes during a competition in tropical climate. METHODS: Fluid intake and pre and post BM were measured in 35 adolescent athletes, and core temperature was measured in one female and one male. RESULTS: Mean urine specific gravity (1.024 [0.007]) indicated that athletes were in suboptimal state of hydration upon waking. Race time was 73.2 (8.0) minutes. BM decreased by 0.6 (0.3) kg (P < .05). Fluid intake (528.5 [221.6] mL) replaced 47% of the fluid loss (1184.9 [256.4] mL) and was higher during run (11.5 [6.6] mL·min-1) compared to bike (7.3 [3.1] mL·min-1), P < .01. Loss in BM was ≥1.0% in 66% and ≥1.5% in 29% of the athletes. Males showed a moderate association between percentage loss in BM and finishing time (r = -.52), higher sweat rates (1.0 [0.3] L·h-1), and faster times (69.4 [7.5] min; P < .05). Core temperature rose to 40.1 °C in the female and 39.6 °C in the male. CONCLUSION: Young triathletes competing in a hot/humid climate became mildly to moderately dehydrated and hyperthermic even when water and sports drinks were available but did not show symptoms of heat illness.

Return-to-Competition Progression After Exertional Heat Stroke in an Adolescent Runner: A Case Report.

A 14-year-old runner indigenous to the tropics collapsed during his first 10-km race in a hot and humid climate. Dizziness, stumbling, and loss of consciousness were symptoms of exertional heat stroke. Two days postcollapse, blood tests revealed elevated hepatic transaminases consistent with hepatic injury. We discuss the return-to-competition progression, which included a gradual increase in exercise duration, initially in a cool and then in a tropical climate, and 2 field-based (wet-bulb globe temperature > 29.0°C) running evaluations that simulated the environmental conditions and training intensity the athlete would encounter in his sport. The thermoregulatory results guided the training progression, his tolerance to running in the heat improved, blood values normalized, and he was cleared to compete in a tropical climate. This exploration case report presents a novel field-based protocol that replicates the physiological demands of training in the tropics to evaluate thermoregulatory responses during exercise-heat stress in young runners after exertional heat stroke to facilitate a safe return to competition.

Evidence for isokinetic and functional testing in return to sport decisions following ACL surgery.

The rupture and reconstruction of the anterior cruciate ligament (ACL) of the knee are associated with an increased risk of functional instability, a reduction in sports performance, and a higher risk of future additional injuries. Competitive athletes who participate in sports that require pivoting, cutting, and jumping are at particularly high risk for ACL rupture. The return to sport progression continuum after surgery includes sports-specific rehabilitation, evaluation of strength and function, gradual participation in exercise training with progressively challenging activities in the field of play, participation in sports at a lower level, and finally a return to preinjury-level sports competition. This narrative review evaluates the evidence that supports the use of quadriceps and hamstrings isokinetic strength testing and sports-specific functional skills assessments to evaluate progress with rehabilitation after ACL surgery. Strength evaluations, hop tests, agility tests, and the limb symmetry index are described, as well as the associations of quadriceps and hamstrings muscle strength and functional test results with successful return to sports and the risk of ACL graft rupture and contralateral knee injuries. Suggestions for future research directions are presented including the importance of presurgery testing, standardization of test batteries, and comparison of test results with normative data.

Assessing the risk of whale entanglement with fishing gear debris.

The loss and abandonment of fishing gear has resulted in one of the most visible signs of growing pollution in the marine environment. The entanglement of whales in fishing gear has been the subject of increasing documentation. The interpretation of the documented incidents to address the risk of whale entanglement is presented. An initial risk-based model is derived that reflects published information on multi-year fishing gear accumulation rates and entanglement data. A fault tree framework is adopted to organize the data, allowing for the continual improvement of the risk-based model predictions through the incorporation of new data and inclusion of additional sub-events. Analytic distribution functions are introduced to augment incomplete data and explore hypothetical scenarios. Data reported for the US Atlantic and Pacific coastlines are used in illustrative examples, that address both regional and multi-regional applications, and the sensitivity of the risk-based predictions to the reported field data.

Normative Data for Sweat Rate and Whole-Body Sodium Concentration in Athletes Indigenous to Tropical Climate.

This study determined normative data for sweat rate (SR) and whole-body (WB) sweat sodium concentration [Na+] in athletes indigenous to a tropical climate, categorized by age, gender, and sport classification. We analyzed data from 556 athletes (386 adult and 170 young) in endurance (END), team/ball (TBA), and combat (COM) sports exercising in tropical environments (wet bulb globe temperature = 29.4 ± 2.1 °C). SR was calculated from change in body weight corrected for urine output and fluid/food intake. Sweat was collected using absorbent patches, and regional [Na+] was determined using an ion selective analyzer and normalized to WB sweat [Na+]. Data are expressed as mean ± SD. SR was higher in males compared with females in both young (24.2 ± 7.7 ml·kg-1·hr-1 vs. 16.7 ± 5.7 ml·kg-1·hr-1) and adult (22.8 ± 7.4 ml·kg-1·hr-1 vs. 18.6 ± 7.0 ml·kg-1·hr-1) athletes, in END sports in girls (END = 19.1 ± 6.0 ml·kg-1·hr-1; TBA = 14.6 ± 4.5 ml·kg-1·hr-1), and in adult males (END = 25.2 ± 6.3 ml·kg-1·hr-1; TBA = 19.1 ± 7.2 ml·kg-1·hr-1; COM = 18.4 ± 8.5 ml·kg-1·hr-1) and females (END = 23.5 ± 5.6 ml·kg-1·hr-1; TBA = 14.2 ± 5.2 ml·kg-1·hr-1; COM = 15.3 ± 5.2 ml·kg-1·hr-1); p < .05. WB sweat [Na+] was higher in adult athletes than in young athletes (43 ± 10 mmol/L vs. 40 ± 9 mmol/L, p < .05). These norms provide a reference range for low, low average, average high, and high SR and WB sweat [Na+], which serve as a guide for fluid replacement for athletes who live and train in the tropics.

Multilevel Interaction Effects of Family and Community Factors on Mothers' Engagement in Evidence-Based Home Visiting.

Informed by ecological and family system frameworks, our study investigated the relationship between family- and community-level factors, and their cross-level interactions, with evidence-based home visiting program participation in a sample of 2409 mothers (mean age: 24.15 years). Using 2-level hierarchical linear modeling, we observed that mothers living in disadvantaged communities demonstrated less active engagement in evidence-based home visiting. Cross-level interaction effects revealed that mothers' unstable living conditions and psychiatric problems amplified the negative influence of disadvantaged communities on program engagement. Conversely, mothers who were first-time parents showed higher levels of participation in family support programs when they resided in disadvantaged communities.

Sweating and core temperature in athletes training in continuous and intermittent sports in tropical climate / Sudoración y temperatura interna en atletas durante entrenamiento para deportes continuos e intermitentes en clima tropical

Higher sweat rate values have been reported during intermittent compared to continuous type exercise in hot conditions in the laboratory. Studies in the training field are scarce. Objective: Document sweat rate, rehydration and core temperature (Tc) during training in long duration-continuous (CON) and intermittent (INT ) type sports, and determine the presence of a mutation in the CFTR gene in athletes with high sodium concentration ([Na+]) in sweat.Methods: Athletes (CON =50 and INT=123) were tested during training in tropical climate. Sweat rate, sweat [Na+], Tc, de-hydration level, and presence of ∆ F508 gene mutation in the CFTR gene in athletes with high sweat [Na+] were evaluated. Results: Sweat rate was higher in CON (1.5 ± 0.4 L/h) compared to INT (1.2 ± 0.5 L/h) and CON athletes finished training with higher dehydration (2.1 ± 0.8 vs 1.2 ± 0.7%) P < 0.05. Sweat [Na+] was higher in INT (62.0 ± 21.1 mmol/L) compared to CON (53.9 ± 18.1 mmol/L), P < 0.05. A tennis player with high [Na+] was heterozygous for the ΔF508 mutation. Average and highest Tc was similar for CON (38.4 ± 0.3 and 38.8 ± 0.4 oC) and INT (38.3 ± 0.3 and 38.7 ± 0.4 oC), P > 0.05. Conclusion: During training in a tropical climate, sweat loss and dehydration level are lower, and fluid intake is higher in intermittent compared to continuous type sports. Core temperature may rise to a similar level in intermittent type sports due to the repeated high intensity bouts and/or the effects of clothing worn while training in hot venues. Healthy athletes with high [Na+] in sweat who are heterozygous carriers of CFTR mutations may be at increased risk for hyponatremic dehydration and whole-body muscle cramps

Se reportan tasas de sudoración más altas durante ejercicio intermitente comparado con continuo en condiciones de calor en el laboratorio. Estudios en el campo de entrenamiento son escasos. Objetivo: Documentar la tasa de sudoración, rehidratación y temperatura central (Tc) durante entrenamiento para deportes de tipo continuo (CON) e intermitente (INT ), y determinar presencia de mutación genética en el gen CFTR en atletas con alta concentración de sodio ([Na+]) en sudor.Metodología: Se evaluó la tasa de sudoración, la [Na+] en sudor, la Tc, y el nivel de deshidratación en atletas (CON = 50; INT =123) durante entrenamiento en clima tropical, y la presencia de la mutación genética ∆F508 en el gen CFTR en aquellos con alta [Na+] en sudor.Resultados: La tasa de sudoración fue mayor en CON (1,5 ± 0,4 L/h) comparado con INT (1,2 ± 0,5 L/h) y los atletas en CON terminaron el entrenamiento con mayor deshidratación (2,1 ± 0,8 vs 1,2 ± 0,7%) P < 0,05. La [Na+] en sudor fue más alta en INT (62,0 ± 21,1 mmol/L) comparado con CON (53,9 ± 18,1 mmol/L), P < 0,05. Un tenista con alta [Na+] era heterocigoto para la mutación ΔF508. La Tc promedio y más alta fueron similares para CON (38,4 ± 0,3 y 38,8 ± 0,4 oC) e INT (38,3 ± 0,3 y 38,7 ± 0,4 oC), P > 0,05. Conclusión: Durante el entrenamiento en clima tropical, la pérdida de sudor y el nivel de deshidratación son más bajos, y la ingesta de líquido es más alta en deportes intermitentes que en deportes continuos. La temperatura interna puede aumentar a nivel similar en deportes intermitentes debido a periodos repetidos de alta intensidad y/o la vestimenta usada durante el entrenamiento. Atletas saludables con alta [Na+] en sudor que son heterocigóticos para mutaciones de CFTR pueden estar en mayor riesgo de deshidratación hiponatrémica y calambres musculares

Principles of exercise physiology: responses to acute exercise and long-term adaptations to training.

Physical activity and fitness are associated with a lower prevalence of chronic diseases, such as heart disease, cancer, high blood pressure, and diabetes. This review discusses the body's response to an acute bout of exercise and long-term physiological adaptations to exercise training with an emphasis on endurance exercise. An overview is provided of skeletal muscle actions, muscle fiber types, and the major metabolic pathways involved in energy production. The importance of adequate fluid intake during exercise sessions to prevent impairments induced by dehydration on endurance exercise, muscular power, and strength is discussed. Physiological adaptations that result from regular exercise training such as increases in cardiorespiratory capacity and strength are mentioned. The review emphasizes the cardiovascular and metabolic adaptations that lead to improvements in maximal oxygen capacity.

Hydration status in adolescent judo athletes before and after training in the heat.

UNLABELLED: Adolescent judo athletes who train in tropical climates may be in a persistent state of dehydration because they frequently restrict fluids during daily training sessions to maintain or reduce their body weight and are not given enough opportunities to drink. PURPOSE: Determine the body hydration status of adolescent judo athletes before, immediately after, and 24 h after (24H) a training session and document sweat Na+ loss and symptoms of dehydration. METHODS: Body mass and urine color and specific gravity (USG) were measured before, after, and 24 h after a training session in a high-heat-stress environment (29.5 ± 1.0°C; 77.7 ± 6.1% RH) in 24 adolescent athletes. Sweat sodium loss was also determined. A comparison was made between mid-pubertal (MP) and late pubertal (LP) subjects. RESULTS: The majority of the subjects started training with a significant level of dehydration. During the training session, MP subjects lost 1.3 ± 0.8% of their pretraining body mass whereas LP subjects lost 1.9 ± 0.5% (P < .05). Sweat sodium concentration was 44.5 ± 23.3 mmol/L. Fluid intake from a water fountain was minimal. Subjects reported symptoms of dehydration during the session, which in some cases persisted throughout the night and the next day. The 24H USG was 1.028 ± 0.004 and 1.027 ± 0.005 g/mL for MP and LP, respectively. CONCLUSIONS: Adolescent judo athletes arrive to practice with a fluid deficit, do not drink enough during training, and experience symptoms of dehydration, which may compromise the quality of training and general well-being.

Buffering Effects of a Family-Based Intervention for African American Emerging Adults.

This study focused on the buffering effects of Adults in the Making (AIM), a family-centered preventive intervention, on the link between life stress and increases in risk behaviors among 347 rural, southern African Americans as they left high school. Of the families, 174 were assigned to the prevention condition and 173 to a control condition. Emerging adults reported risk behaviors at pretest, posttest (7 months after pretest), and long-term follow-up (10 months after posttest). A significant Life stress × Prevention condition interaction emerged: Increases in risk behaviors were significantly greater among emerging adults in the control condition who experienced high stress levels than among those in the prevention condition who experienced equally high stress levels.

Long-term effects of the strong African American families program on youths' alcohol use.

OBJECTIVE: This report extends earlier accounts by addressing the effects of the Strong African American Families (SAAF) program across 65 months. Two hypotheses were tested: (a) Rural African American youths randomly assigned to participate in SAAF would demonstrate lower rates of alcohol use than would control youths more than 5 years later, and (b) SAAF's effects on deterring the onset of alcohol use in early adolescence would carry forward to mediate the program's long-term effects. METHOD: African American youths in rural Georgia (mean age at pretest = 10.8 years) were assigned randomly to the SAAF group (n = 369) or to a control group (n = 298). Past-month alcohol use was assessed at pretest and at 9, 18, 29, 53, and 65 months after pretest. RESULTS: SAAF participants increased their alcohol use at a slower rate than did adolescents in the control condition across the follow-up assessments. At the 65-month assessment, SAAF participants reported having drunk alcohol half as often as did youths in the control group. Consistent with the second hypothesis, SAAF's effects on deterring initiation carried forward to account for its effects on alcohol use across time. CONCLUSIONS: Training in protective parenting processes and self-regulatory skills during preadolescence may contribute to a self-sustaining trajectory of disinterest in and avoidance of alcohol use during adolescence when peers begin to model and sanction it.

Parenting moderates a genetic vulnerability factor in longitudinal increases in youths' substance use.

The authors used a longitudinal, prospective design to investigate a moderation effect in the association between a genetic vulnerability factor, a variable nucleotide repeat polymorphism in the promoter region of 5HTT (5-HTTLPR), and increases in youths' substance use. The primary study hypothesis predicted that involved-supportive parenting would attenuate the link between the 5-HTTLPR polymorphism and longitudinal increases in substance use. African American youths residing in rural Georgia (N = 253, mean age = 11.5 years) provided 4 waves of data on their own substance use; the mothers of the youths provided data on their own parenting practices. Genetic data were obtained from youths via saliva samples. Latent growth curve modeling indicated that 5-HTTLPR status (presence of 1 or 2 copies of the s allele) was linked with increases in substance use over time; however, this association was greatly reduced when youths received high levels of involved-supportive parenting. This study demonstrates that parenting processes have the potential to ameliorate genetic risk.

Self-reported physical activity in Hispanic adults living with HIV: comparison with accelerometer and pedometer.

Limited information is available regarding physical activity (PA) and its assessment in Hispanics living with HIV. This study compared self-reported PA using the International Physical Activity Questionnaire (IPAQ) with objectively measured PA using the ActiGraph accelerometer and DigiWalker pedometer in 58 Hispanic adults with HIV. IPAQ was administered before and after a 7-day period in which subjects wore the ActiGraph and DigiWalker. PA classification was based on > or = 150 min/wk (IPAQ, ActiGraph) and > or = 10,000 steps/day (DigiWalker). IPAQ-PA was higher than ActiGraph-PA (423 +/- 298 vs. 165 +/- 134 min/wk, respectively) (p < .01). There was a mismatch in PA classification with the IPAQ, ActiGraph, and DigiWalker (active = 81%, 54%, and 17%, respectively). Hispanics with HIV highly overestimated self-reported PA. Nurse scientists and other investigators must consider accelerometers or pedometers to assess PA in this population.

Psychological functioning, support for self-management, and glycemic control among rural African American adults with diabetes mellitus type 2.

OBJECTIVE: To test a contextual-ecological model of factors relevant for glycemic control in an understudied and vulnerable population of persons with diabetes mellitus Type 2. DESIGN: Rural African American adults (40-65 years old, n = 200) with Type 2 diabetes and 200 adult support persons whom the adults with diabetes nominated were interviewed in their homes. Adults with diabetes and support persons reported their own psychological functioning, which included depressive symptoms, self-esteem levels, and optimism levels as well as the quality of their relationship with one another. Adults with diabetes reported the extent and quality of the instrumental and emotional support they received from their support persons. RESULTS: Structural equation modeling indicated that psychological functioning among the adults with diabetes and support persons was associated with the latter's provision of support for diabetes self-management. Support, in turn, was linked indirectly with glycemic control as assessed via glycosylated hemoglobin levels, through promotion of glucose monitoring. CONCLUSION: Targeting sources of support in patients' immediate social contexts is important to the improvement of self-care and deterring of morbidity among rural African Americans with Type 2 diabetes.

Voluntary drinking and hydration in trained, heat-acclimatized girls exercising in a hot and humid climate.

This study examined the effects of beverage composition on the voluntary drinking pattern, body fluid balance and body temperature responses of heat-acclimatized trained girls exercising intermittently in outdoor conditions (WBGT = 30.9 +/- 0.2 degrees C). Twelve trained, heat-acclimatized girls (age = 10.6 +/- 0.2 years) performed three 3-h sessions, each consisting of four 20-min cycling bouts at 60% VO2max, alternating with 25-min rest. One of three beverages was assigned: unflavored water (W), flavored water (FW) or flavored water plus 6% carbohydrate and 18 mmol/l NaCl (CNa). Drinking was ad libitum. Total intake was similar among conditions (W = 953.3 +/- 107.8 ; FW = 1026.5 +/- 138.1; CNa = 906.4 +/- 107.5 g). A mild hypohydration occurred during the three conditions (W = -1.12%; FW = -0.95%; CNa = -0.74% BW, P > 0.05). Sweat loss, higher than previously reported for sedentary girls, was not different among conditions (W = 1,051.5 +/- 90.8; FW = 979.9 +/- 72.8; CNa = 1,052.7 +/- 52.6 g). The average amount of urine produced (W = 269.8 +/- 85.9; FW = 320.8 +/- 87.2; CNa = 85.6 +/- 9.3 g) was 73 and 68% lower [corrected] during CNa compared to [corrected] FW and W, respectively, [corrected] (CNa vs. FW, P < 0.05), CNa vs W, P = 0.06) [corrected] The increase in rectal temperature, heart rate and all perceptual variables did not differ among conditions. In conclusion, flavoring of the water and addition of 6% carbohydrate plus 18 mmol/l NaCl do not prevent mild hypohydration in trained, heat-acclimatized girls with high sweating rates. However, there is a tendency towards a greater fluid retention with the CNa beverage.

Voluntary drinking and hydration in non-acclimatized girls exercising in the heat.

The intent of this study was to assess the influence of drink flavor and composition on voluntary drinking and hydration status in girls exercising intermittently in the heat (35 +/- 1 degrees C, 45-50% relative humidity). Twelve physically active, nonacclimatized girls (9-12 years) performed three 3 h identical sessions, each consisting of four 20 min cycling bouts at 50% (VO(2max)), separated by 25 min of rest. One of the three beverages (chilled to 8-10 degrees C) was assigned to each session: unflavored water (W), grape-flavored water (FW) and grape-flavored water plus 6% carbohydrate and 18 mmol l(-1) NaCl (CNa). Drinking was ad libitum. Body weight (BW), drink intake (DI), heart rate, rectal and skin temperatures, and perceptions of thirst and stomach fullness were monitored periodically. Total DI was 759, 940, 1,045 g in W, FW and CNa, respectively (P < 0.05 for CNa-W and FW-W). BW changes were -0.15, 0.16, and 0.45% in W, FW and CNa, respectively, but only the difference between CNa and W was significant (P < 0.05). Other physiological and perceptual variables were not different between trials. In conclusion, beverage flavoring regardless if its combination with carbohydrate and NaCl, mildly enhanced voluntary drinking in young non-acclimatized girls. In contrast to previous research in young boys, euhydration was maintained in the girls by an adequate intake of unflavored water.

A profile of canadian pediatric occupational therapy practice.

PURPOSE: This study established a current profile of Canadian pediatric occupational therapy practice in terms of theories/practice models, assessments, and interventions. METHOD: Respondents were 272 members of the Canadian Association of Occupational Therapists who indicated that pediatrics was their primary area of clinical practice. A purpose-designed survey was mailed to participants. RESULTS: The response rate was adequate at 27.2% (n = 272/1,000). The primary client groups seen by pediatric therapists were developmental delay, learning disability, neurology, and those requiring rehabilitation. Sensory Integration and Client-Centred Practice were the most frequently utilized theories/practice models. The most commonly used assessments were the Developmental Test of Visual Motor Integration, Peabody Developmental Motor Scales, Bruininks-Oseretsky Test of Motor Proficiency, and the Sensory Profile. The most frequently used intervention techniques with pediatric clients were the instruction of parents/caregivers and children; assistive devices, adaptive equipment, and technology; activities of daily living/self-care skills; and environmental modification/access/structuring/adaptation. CONCLUSIONS: Pediatric occupational therapists mainly used theories/ practice models that focused on three areas: Client-Centred practice, practice-oriented theories, and several theories/practice models based on occupation. Interventions focused on teaching, activities unique to occupational therapy, and on the functional needs of the client.

A comparison of paediatrics occupational therapy university program curricula in New Zealand, Australia, and Canada.

Comparisons were made of the paediatric content of professional entry-level occupational therapy university program curricula in Australia, New Zealand, and Canada using an ex post facto survey methodology. The findings indicated that in Australia/New Zealand, paediatrics made up 20% of the total curriculum, but only 13% in Canada. Canadian reference materials were utilized less often in Canadian universities than in Australia/New Zealand. Theories taught most often in Australia/New Zealand were: Sensory Integration, Neurodevelopmental Therapy, Client-Centered Practice, Playfulness, and the Model of Human Occupation. In Canada, the most frequent theories were: Piaget's Stages of Cognitive/Intellectual Development, Neurodevelopmental Therapy, Erikson's Eight Stages of Psychosocial Development and Sensory Integration. The most frequently taught paediatric assessment tools in both regions were the Bruininks-Oseretsky Test of Motor Proficiency and Miller Assessment for Preschoolers. Paediatric intervention methods taught to students in all three countries focused on activities of daily living/self-care, motor skills, perceptual and visual motor integration, and infant and child development.