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Changes in hydration status occur throughout the day affecting physiological and behavioural functions. However, little is known about the hydration status of free-living Japanese children and the seasonality of this response. We evaluated hydration status estimated by urine osmolality (Uosm) in 349 children (189 boys and 160 girls, 9.5 ± 2.6 years, range: 6–15 years) upon waking at home and during a single school day in spring (April) and summer (July). Further, we assessed the efficacy of employing self-assessment of urine colour (UC; based on an 8-point scale) by children to monitor their hydration status. Early morning Uosm was greater in the spring (903 ± 220 mOsm L−1; n = 326) as compared to summer (800 ± 244 mOsm L−1; n = 125) (P = 0.003, paired t test, n = 104). No differences, however, were observed in Uosm during the school day (P = 0.417, paired t test, n = 32). While 66% and 50% of children were considered underhydrated (Uosm ≥ 800 mOsm L−1) upon waking in the spring and summer periods, respectively, more children were underhydrated (∼12%) during the school day. Self-reported UC was similar between seasons as assessed in the morning and school day (P ≥ 0.101, paired t test), which differed from the pattern of responses observed with Uosm. We showed that a significant number of Japanese children are likely underhydrated especially in the spring period. Children do not detect seasonal changes in hydration from self-assessed UC, limiting its utility to manage hydration status in children. [ABSTRACT FROM AUTHOR]

Exertional heat stroke (EHS) is a medical emergency whose likelihood in sport settings is often contingent on environmental factors, team policies, coaching strategies, and broader cultural expectations. Moreover, when it occurs, it requires immediate recognition, proper management, and care to optimize chances of survival or recovery without long-term sequelae. Max Gilpin, a secondary school American football player from Louisville, Kentucky, suffered an EHS during a football practice in August 2008, an event that resulted in his death. The purpose of this article is to use interdisciplinary methods to identify key factors that contributed to this tragedy so that similar situations do not happen again. It concludes that within a culture of inclusive gender norms and care, efforts should be made to have appropriate onsite medical expertise available to develop and implement best practices for the prevention, management, and treatment of EHS, along with coaching education specific to medical emergencies in sport and physical activity (such as EHS). This will create an environment that promotes health and safety for all student athletes participating in sport at the secondary school level.

Purpose: To assess elite racewalkers' preparation strategies, knowledge, and general practices for competition in the heat and their health status during the World Athletics Race Walking Teams Championships (WRW) Muscat 2022. Methods: Sixty-six elite racewalkers (male: n = 42; mean age = 25.8 y) completed an online survey prior to WRW Muscat 2022. Athletes were grouped by sex (males vs females) and climate (self-reported) they live/trained in (hot vs temperate/cold), with differences/relationships between groups assessed. Relationships between ranking (medalist/top 10 vs nonmedalist/nontop 10) and precompetition use of heat acclimation/acclimatization (HA) were assessed. Results: All surveyed medalists (n = 4) implemented, and top 10 finishers were more likely to report using (P =.049; OR = 0.25; 95% CI, 0.06%–1%), HA before the championships. Forty-three percent of athletes did not complete specific HA training. Females (8% [males 31%]) were less likely to have measured core temperature (P =.049; OR = 0.2; 95% CI, 0.041–0.99) and more likely to not know expected conditions in Muscat (42% vs 14%; P =.016; OR = 4.3; 95% CI, 1%–14%) or what wet bulb globe temperature is (83% vs 55%; P =.024; OR = 4.1; 95% CI, 1%–14%). Conclusions: Athletes who implemented HA before the championships tended to place better than those who did not. Forty-three percent of athletes did not prepare for the expected hot conditions at the WRW Muscat 2022, primarily attributed to challenges in accessing and/or cost of equipment/facilities for HA strategies. Further efforts to bridge the gap between research and practice in this elite sport are needed, particularly in female athletes. [ABSTRACT FROM AUTHOR]

Context: Each country has a unique history in the development of its athletic training professionals and education and credentialing systems. In Japan, the majority of athletic trainers hold a domestic credential (JSPO-AT) obtained from the Japan Sport Association (JSPO) or a US-based credential from the Board of Certification (BOC-AT). Objective: To determine whether differences in demographic, professional, and educational characteristics exist between Japanese BOC-ATs and JSPO-ATs who currently practice athletic training services in Japan. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: Eight hundred twenty-nine Japanese athletic trainers in Japan (BOC-AT, n=64; JSPO-AT, n=765). (s): Pearson's Xsuperscript 2]test and Fisher's exact test were used to determine differences in demographic, professional, and educational characteristics between BOC-ATs and JSPO-ATs. Results: The proportion of female respondents was greater for BOC-ATs (29.7%) than for JSPO-ATs (18.7%; X[superscript 2] [1]=4.5, P=0.03). A greater proportion of BOC-ATs reported having master's degrees or higher (X[superscript 2] [3]=81.6, P[less than]0.01). The percentage of respondents with at least 1 therapist or medical practitioner license in Japan was greater for JSPO-ATs (73.1%) than for BOC-ATs (20.3%; P[less than] 0.01). The percentage of respondents with at least 1 credential in exercise, nutrition, or teaching was greater for BOC-ATs (62.5%) than for JSPO-ATs (45.2%; P[less than]0.01). A large difference was observed in the proportion of individuals who identified as therapists (JSPO-ATs= 29.8%, BOC-ATs=6.3%; X[superscript 2] [5]= 18.9, P[less than] 0.01). The median income for BOC-ATs was 401-600 million yen (US $36,500-$54,500), whereas the median income for JSPO-ATs was 0-200 million yen (US$0-$18,200). Conclusions: BOC-ATs in Japan were more established than JSPO-ATs as athletic training professionals with higher educational backgrounds, while more JSPO-ATs tended to be therapists. Findings from the current study may serve as benchmark data for the athletic training profession and service characteristics in Japan.

Few authors have investigated sport-related concussion (SRC) awareness and knowledge among athletes in Japan. Sport-related concussion research is scarce among Asian compared with North American and European cohorts. To examine previous SRC history, level of SRC knowledge, and previous exposure to SRC education among collegiate athletes in Japan by the level of contact and access to medical staff. Cross-sectional study. Single-university study in Japan. A total of 2103 athletes (48 varsity teams) were contacted to participate in an anonymous survey. Data from athletes with (1) SRC history in the past 3 months, (2) persistent SRC symptoms, (3) nontraditional sports, or (4) incomplete surveys were excluded. As a result, data from 593 athletes representing 43 varsity teams were included in this analysis. Outcome measures were level of contact (contact [CON], limited contact [LTD], noncontact [NC]), access to medical staff (MEDYES, MEDNO), SRC knowledge (maximum score of 49), previous SRC history (self-report; yes, no), and previous SRC education (self-report; yes, no). The average SRC knowledge total score was 33.4 ± 6.1 (range, 18–48). The knowledge score in CON was higher than in LTD and NC (P <.001) and in MEDYES than MEDNO (median, MEDYES = 34.0, MEDNO = 32.0; U = 27 841.5, P <.001). Sport-related concussion history was statistically different by the level of contact (= 27.95, P <.001) and by access to medical staff (= 4.5, P =.034). The presence of an SRC history and previous SRC education contributed to higher SRC knowledge, independent of the level of contact and access to medical staff (P <.001). Japanese athletes who participated in CON sports had a higher prevalence of SRC history, higher knowledge, and greater exposure to SRC education than those in LTD or NC sports. Access to medical staff was associated with higher SRC knowledge. [ABSTRACT FROM AUTHOR]

An emergency action plan (EAP) is a written document detailing the preparations and on-site emergency response of health care professionals and other stakeholders to medical emergencies in the prehospital setting. The EAP is developed to address any type of catastrophic injury response and should not be condition specific. The objective of this National Athletic Trainers' Association position statement is to provide evidence-based and consensus-based recommendations for developing and implementing an EAP for sports settings. These recommendations were developed by a multidisciplinary expert panel that performed (1) a comprehensive review of existing EAP evidence, (2) a modified Delphi process to define consensus recommendations, and (3) a strength of recommendation taxonomy determination for each recommendation. An EAP is an essential tool designed to facilitate emergency preparedness and an efficient, coordinated emergency response during an athletic event. A comprehensive EAP should consider modes to optimize patient outcomes, the various stakeholders needed to develop the plan, the factors influencing effective implementation of the EAP, and the roles and responsibilities to ensure a structured response to a catastrophic injury. These evidence-informed recommendations outline the necessary steps for emergency planning and provide considerations for the immediate management of patients with catastrophic injuries. Increasing knowledge and implementation of the EAP to manage patients with catastrophic injuries improves the overall response and decreases errors during an emergency. [ABSTRACT FROM AUTHOR]

The wet bulb globe temperature (WBGT) is widely used in athletics for assessing heat stress. Sports governing bodies provide a wide variety of recommendations on how often to take WBGT measurements during activities like practices and competitions. This can leave coaching staff and other sports medicine personnel in a quandary as to what is the "best practice." Our study is the first to use a large dataset to quantify the variability of WBGT within practice and competition sessions, and to identify the impact of using different measurement rates on the WBGT. The study leverages 6 years of data from thousands of American football practice and competition sessions from across Georgia, USA. We observed that, on average, WBGTs are coolest in the morning (26.67°C) and evening (24.84°C), and hottest in the midday (30.23°C) and afternoon (27.21°C). The variability within sessions tended to be greater for morning, midday, and afternoon than evenings, with session standard deviations of 0.96°C to 1.27°C and ranges of 2.67°C to 3.55°C when controlling for duration. WBGTs also tended to increase over time in morning sessions and decrease over time during afternoon and evening sessions. These changes are clinically important. We found that Georgia High School Association (GHSA) WBGT activity modification categories often changed during sessions, especially in the morning, midday, and afternoon where a change in GHSA category of ≥1 occurred in 57% to 76% of sessions. Considering this variability, our results indicate that more frequent measurements better capture maximum WBGT values over a session and reduce the likelihood of misclassifying activity modification. [ABSTRACT FROM AUTHOR]

A high number of exertional heat stroke (EHS) cases occur during the Falmouth Road Race. To extend previous analyses of EHS cases during the Falmouth Road Race by assessing or describing (1) EHS and heat exhaustion (HE) incidence rates, (2) EHS outcomes as they relate to survival, (3) the effect of the environment on these outcomes, and (4) how this influences medical provider planning and preparedness. Descriptive epidemiologic study. Falmouth Road Race. Patients with EHS or HE admitted to the medical tent. We obtained 8 years (2012 to 2019) of Falmouth Road Race anonymous EHS and HE medical records. Meteorologic data were collected and analyzed to evaluate the effect of environmental conditions on the heat illness incidence (exertional heat illness [EHI] = EHS + HE). The EHS treatment and outcomes (ie, cooling time, survival, and discharge outcome), number of HE patients, and wet bulb globe temperature (WBGT) for each race were analyzed. A total of 180 EHS and 239 HE cases were identified. Overall incidence rates per 1000 participants were 2.07 for EHS and 2.76 for HE. The EHI incidence rate was 4.83 per 1000 participants. Of the 180 EHS cases, 100% survived, and 20% were transported to the emergency department. The WBGT was strongly correlated with the incidence of both EHS (r2 = 0.904, P =.026) and EHI (r2 = 0.912, P =.023). This is the second-largest civilian database of EHS cases reported. When combined with the previous dataset of EHS survivors from this race, it amounts to 454 EHS cases resulting in 100% survival. The WBGT remained a strong predictor of EHS and EHI cases. These findings support 100% survival from EHS when patients over a wide range of ages and sexes are treated with cold-water immersion. [ABSTRACT FROM AUTHOR]