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This JAMA Insights discusses heat-related illness in athletes, including risk factors, prevention, symptoms, and management. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of and risk factors for exertional heat illness (EHI) and cold weather injury (CWI) in the U.S. Army have been well documented. The "heat season", when the risk of EHI is highest and application of risk mitigation procedures is mandatory, has been arbitrarily defined as May 1 through September 30, while the "cold season" is understood to occur from October 1 to April 30 each year. The proportions of EHI and CWI that occur outside of the traditional heat and cold seasons are unknown. Additionally, it is unknown if either of the seasonal definitions are appropriate. The primary purpose of this study was to determine the proportion of EHI and of CWI that occur within the commonly accepted seasonal definitions. We also report the location-specific variability, seasonal definitions, and the demographic characteristics of the populations.Methods: The U.S. Army installations with the highest frequency of EHI and of CWI from 2008 to 2013 were identified and used for analysis. In total there were 15 installations included in the study, with five installations used for analysis in both the EHI and CWI projects. In- and out-patient EHI and CWI data (ICD-9-CM codes 992.0 to 992.9 and ICD codes 991.0 to 991.9, respectively) were obtained from the Defense Medical Surveillance System. Installation-specific denominator data were obtained from the Defense Manpower Data Center, and incidence rates were calculated by week, for each installation. Segmental (piecewise) regression analysis was used to determine the start and end of the heat and cold seasons.Results: Our analysis indicates that the heat season starts around April 22 and ends around September 9. The cold season starts on October 3 and ends on March 24. The majority (n = 6,445, 82.3%) of EHIs were diagnosed during the "heat season" of May 1 to September 30, while 10.3% occurred before the heat season started (January1 to April 30) and 7.3% occurred after the heat season ended (October 1 to December 31). Similar to EHI, 90.5% of all CWIs occurred within the traditionally defined cold season, while 5.7% occurred before and 3.8% occurred after the cold season. The locations with the greatest EHI frequency were Ft Bragg (n = 2,129), Ft Benning (n = 1,560), and Ft Jackson (n = 1,538). The bases with the largest proportion of CWI in this sample were Ft Bragg (17.8%), Ft Wainwright (17.2%), and Ft Jackson (12.7%). There were considerable inter-installation differences for the start and end dates of the respective seasons.Conclusions: The present study indicates that the traditional heat season definition should be revised to begin  ∼3 weeks earlier than the current date of May 1; our data indicate that the current cold season definition is appropriate. Inter-installation variability in the start of the cold season was much larger than that for the heat season. Exertional heat illnesses are a year-round problem, with ∼17% of all cases occurring during non-summer months, when environmental heat strain and vigilance are lower. This suggests that EHI mitigation policies and procedures require greater year-round emphasis, particularly at certain locations. [ABSTRACT FROM AUTHOR]

Aged humans often exhibit an impaired defense of core temperature during cold stress. However, research documenting this response has typically used small subject samples and strong cold stimuli. The purpose of this study was to determine the responses of young and older subjects, matched for anthropometric characteristics, during mild cold stress. Thirty-six young (YS; 23 [+ or -] 1 years, range 18-30) and 46 older (OS; 71 [+ or -] 1 years, range 65-89) subjects underwent a slow transient cold air exposure from a thermoneutral baseline, during which esophageal ([T.sub.es]) and mean skin temperatures ([T.sub.sk]), [O.sub.2] consumption, and skin blood flow (SkBF; laser-Doppler flowmetry) were measured. Cold exposure was terminated at the onset of visible sustained shivering. Net metabolic heat production ([M.sub.net]), heat debt, predicted change in midregion temperature ([DELTA][T.sub.mid]), and tissue insulation ([I.sub.t]) were calculated. Cutaneous vascular conductance (CVC) was calculated as laser-Doppler flux/mean arterial pressure and expressed as percent change from baseline ([DELTA]CV[C.sub.%base]). There were no baseline group differences for [T.sub.es], but OS [M.sub.net] was lower (OS: 38.0 [+ or -] 1.1; YS: 41.9 [+ or -] 1.1 W*[m.sup.-2], P < 0.05). Ten was well maintained in YS but fell progressively in OS (P < 0.01 for all timepoints after 35 min). The skin vasoconstrictor response to mild cold stress was attenuated in OS (42 [+ or -] 3 vs. 53 [+ or -] 4 [DELTA]CV[C.sub.%base] P < 0.01). There were no group differences for [T.sub.sk] or [I.sub.t], while [M.sub.net] remained lower in OS (P < 0.05). The [DELTA][T.sub.mid] did not account for the drop in [T.sub.es] in OS. Healthy aged humans failed to maintain [T.sub.es]; however, the mechanisms underlying this response are not clear. skin blood flow; core temperature