Contemporary Issue: Health and Safety of Female Wrestlers.

ABSTRACT: Female wrestling has grown exponentially over the past decade. Within the United States, 46 states now recognize female high school wrestling, and 153 colleges have programs. It is on track to become an NCAA championship-level sport in 2026. A primary health and safety risk among this cohort pertains to rapid weight loss strategies. These can lead to intentional caloric restriction and decreased body fatness, with the perceived goal of attaining a competitive advantage. Low energy availability and low body fatness are associated with a number of health concerns including menstrual dysfunction and loss of bone mineral density in girls and women. The current recommendation of 12% as a minimum for percentage body fat is very likely too low, opening the door for health perturbations among this population. The minimum threshold might more appropriately fall within the range of 18% to 20%. Body fat assessment methods, primarily skinfold measures that are used to guide weight class selection, have not been adequately validated among this population and therefore should be an area of research focus, while also exploring alternative assessment techniques. Further, we recommend that weight cycling, restrictive energy intake, and intentional dehydration be avoided. Research should assess the effects of frequent weight cycling (to "make weight") and prolonged periods of low body fat on the reproductive and bone health of these athletes. Finally, research and clinical evaluations on female wrestlers are limited, and we offer a list of research priorities for future investigation into this contemporary issue.

Chronic hepatitis C virus infections in Switzerland in 2020: Lower than expected and suggesting achievement of WHO elimination targets.

In this multi-method study, we investigated the prevalence of chronic infections with the hepatitis C virus (HCV) in Switzerland in 2020, and assessed Switzerland's progress in eliminating HCV as a public health problem by 2030 with regard to the World Health Organization (WHO) criteria targeting infections acquired during the preceding year ('new transmissions') and HCV-associated mortality. Based on a systematic literature review, the reappraisal of a 2015 prevalence analysis assuming 0.5% prevalence among the Swiss population and data from many additional sources, we estimated the prevalence among subpopulations at increased risk and the general population. For new transmissions, we evaluated mandatory HCV notification data and estimated unreported new transmissions based on subpopulation characteristics. For the mortality estimate, we re-evaluated a previous mortality estimate 1995-2014 based on new data on comorbidities and age. We found a prevalence of ≤0.1% among the Swiss population. Discrepancies to the 2015 estimate were explained by previous (i) underestimation of sustained virologic response numbers, (ii) overestimation of HCV prevalence among PWID following bias towards subgroups at highest risk, (iii) overestimation of HCV prevalence among the general population from inclusion of high-risk persons and (iv) underestimation of spontaneous clearance and mortality. Our results suggest that the WHO elimination targets have been met 10 years earlier than previously foreseen. These advancements were made possible by Switzerland's outstanding role in harm-reduction programmes, the longstanding micro-elimination efforts concerning HIV-infected MSM and nosocomial transmissions, little immigration from high-prevalence countries except Italian-born persons born before 1953, and wealth of data and funding.

Collegiate women's wrestling body fat percentage and minimum wrestling weight values: time for revisiting minimal body fat percent?

BACKGROUND: The estimation of body fat percentage (BF%) in wrestling is used to determine the minimum wrestling weight (MWW) and lowest allowable weight class (MWC) in which wrestlers are eligible to compete. A 12% minimum threshold is currently used for women wrestlers, yet a potential increase for safety has been discussed. Because of the novelty of collegiate women's wrestling, there is a paucity of literature available on the body composition norms of this population. The purpose of this study was to provide a descriptive summary of BF% and MWW values of female wrestlers and how MWW values would change with the use of different BF% thresholds. METHODS: Data from the 2022-2023 collegiate season were retrospectively analyzed resulting in a sample of 1,683 collegiate women wrestlers from the National Association of Intercollegiate Athletics (NAIA, n = 868) and the National Collegiate Athletics Association (NCAA, n = 815). All wrestlers completed skinfold assessments for weight certification at the start of the competition season. The skinfold values were used to estimate BF% using the Slaughter skinfold prediction equation. Frequency statistics and descriptive analysis were performed to compute normative MWW and BF% profiles. BF% thresholds of 12% (12MWW) and the BF% value defined as the lowest 5th percentile, which would be considered unusually lean, were used to determine the resulting MWW and MWC for each method. The lowest recorded weight and weight class division throughout the season was also recorded for each wrestler. RESULTS: There was a positively skewed (0.94) and platykurtic (1.86) distribution of MWW values. The median ± interquartile range BF% for all wrestlers was 27.4 ± 10.22%, with 17% BF representing the 5th percentile. Only 354 out of 1,579 (22.4%) wrestlers competed in their lowest allowable weight class, based on the 12MWW. Of these 354 wrestlers, the mean BF% was 21.3 ± 5.2% at weight certification with only n = 17 being at or below 12% body fat and an average weight loss of 11.1 ± 8.8 lbs. from the time of weight certification. Throughout the season, wrestlers competed at weights that were, on average (mean ± SD), 19.4 ± 16.9 lbs. higher than their 12MWW (95% CI: 18.6, 20.2 lbs. p < 0.001; effect size [ES] = 1.1), 13.4 ± 19.0 lbs. higher than the 17MWW (p < 0.001; ES = 0.70), and 8.7 ± 8.3 lbs. lower than their weight at the certification (95% CI: 8.3, 9.1 lbs. p < 0.001; ES = 1.1). CONCLUSIONS: Nearly all BF% values were well above the 12% threshold used to determine MWW. Increasing the minimum BF% threshold from 12% to 17% would affect a small percentage of wrestlers, likely reduce the need for excessive weight cutting, and minimize the deleterious health effects of an athlete at such a low BF%.

Swiss multicenter study evaluating the efficacy, feasibility and safety of peginterferon-alfa-2a and ribavirin in patients with chronic hepatitis C in official opiate substitution programs.

BACKGROUND: Though patients in opiate substitution programs are commonly infected with HCV, due to safety and efficacy concerns, they are rarely treated with interferon and ribavirin. METHODS: In a multicenter study, HCV-infected patients in opiate maintenance treatment programs received 180 microg pegylated interferon-alfa-2a once weekly, plus daily ribavirin for 24 weeks (genotypes 2, 3), or 48 weeks (genotypes 1, 4). RESULTS: Of the 67 patients enrolled, 31 (46%) had HCV genotypes 1 or 4, and 36 (54%) had genotypes 2 or 3. Intent-to-treat analysis showed end-of-treatment virologic response in 75% of patients (81% of genotypes 2 or 3; 65% of genotypes 1 or 4), and a sustained virologic response in 61% of patients (72% of genotypes 2 or 3; 48% of genotypes 1 or 4). Fifteen patients (22%) did not complete the study, in 5 (8%) cases because of severe adverse events. CONCLUSIONS: Drug users with chronic HCV infection, regularly attending an opiate maintenance program in which close collaboration between hepatologists/internists and addiction specialists is assured, can be treated effectively and safely with pegylated interferon-alfa-2a and ribavirin. Treatment results are very similar to those in other patient groups, and thus therapy should also be considered for this population.

NCAA rule change improves weight loss among national championship wrestlers.

PURPOSE: The present investigation was initiated to examine the weight management practices among wrestlers participating in the NCAA Division I, II, and III wrestling tournaments. Part 1 examined the efficacy of body composition assessment between preseason (PRE) and postseason (POST). Part 2 examined rapid weight loss (RWL) during the 20 h preceding the weigh-in and the rapid weight gained (RWG) during the first day's competition. METHODS: Subjects include 811 competitors from Divisions I, II, and III participating in the NCAA national championship tournaments between 1999 and 2004. Measurements included relative body fatness (% BF) and weight (WT) on the day preceding the tournament and the evening of the first day. Minimal weight (MW) was computed with 5% BF. Retrospectively, MW, % BF, and WT from the previous fall were obtained for comparisons from NCAA records. RESULTS: Part 1: WT and % BF decreased significantly PRE (WT 74.0 +/- 11.1 kg; % BF 12.3 +/- 3.4%) to POST (WT 71.5 +/- 10.4 kg; % BF 9.5 +/- 1.8%), but MW (PRE MW 68.0 +/- 9.2 kg, POST MW 67.9 +/- 9.1 kg) remained unchanged. Heavier wrestlers and Division I and II wrestlers showed the greatest changes in WT and % BF. Part 2: RWL averaged (+/- SD) 1.2 +/- 0.9 kg and relative to weight 1.7 +/- 1.2%. Division I and lighter wrestlers showed the greatest change. RWG averaged 0.9 +/- 0.8 kg, or 1.3 +/- 1.2%. RWG was greater among lighter and Division I and II wrestlers. CONCLUSIONS: Minimal weight estimates PRE appear valid compared with POST. RWL and RWG are reduced significantly over previous investigations with only mat-side weigh-ins. The NCAA weight management program appears effective in reducing unhealthy weight cutting behaviors and promoting competitive equity. Efforts to institute similar programs among younger wrestlers seem warranted.

Hydration testing of athletes.

Dehydration not only reduces athletic performance, but also places athletes at risk of health problems and even death. For athletes, monitoring hydration has significant value in maximising performance during training and competition. It also offers medical personnel the opportunity to reduce health risks in situations where athletes engage in intentional weight loss. Simple non-invasive techniques, including weight monitoring and urine tests, can provide useful information. Bioimpedance methods tend to be easy to use and fairly inexpensive, but generally lack the precision and accuracy necessary for hydration monitoring. Blood tests appear to be the most accurate monitoring method, but are impractical because of cost and invasiveness. Although future research is needed to determine which hydration tests are the most accurate, we encourage sports teams to develop and implement hydration monitoring protocols based on the currently available methods. Medical personnel can use this information to maximise their team's athletic performance and minimise heat- and dehydration-related health risks to athletes.

Descriptive epidemiology of collegiate men's wrestling injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004.

OBJECTIVE: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's wrestling and identify potential areas for injury prevention initiatives. BACKGROUND: From 1988-1989 through 2003-2004, 17% of NCAA schools sponsoring varsity men's wrestling programs participated in annual Injury Surveillance System (ISS) data collection. MAIN RESULTS: Patterns of injury were consistent with the person-to-person, combative contact between wrestlers. The musculoskeletal system and head were the most vulnerable areas during competitions; skin infections are a continuing concern in the practice environment. The incidence of injuries in practices exhibited no significant increase over time, a positive trend that may be consistent with the influence of the recent NCAA weight management rules. RECOMMENDATIONS: Expansion of the present ISS to include indirect causes of injury, such as weight loss practices, would strengthen the analysis of data. Efforts by referees to be vigilant for potentially dangerous holds and by athletic trainers to improve wrestler and mat hygiene should be continued.

Accuracy of urine specific gravity and osmolality as indicators of hydration status.

To reduce the adverse consequences of exertion-related and acute intentional dehydration research has focused on monitoring hydration status. This investigation: 1) compared sensitivity of urine specific gravity (Usg), urine osmolality (U(osm)) and a criterion measurement of hydration, plasma osmolality (P(osm)), at progressive stages of acute hypertonic dehydration and 2) using a medical decision model, determined whether Usg or U(osm) accurately reflected hydration status compared to P(osm) among 51 subjects tested throughout the day. Incremental changes in P(osm) were observed as subjects dehydrated by 5% of body weight and rehydrated while Usg and U(osm) showed delayed dehydration-related changes. Using the medical decision model, sensitivity and specificity were not significant at selected cut-offs for Usg and U(osm). At the most accurate cut-off values, 1.015 and 1.020 for Usg and 700 m(osm)/kg and 800 m(osm)/kg for U(osm), only 65% of the athletes were correctly classified using Usg and 63% using U(osm). P(osm), Usg, and U(osm) appear sensitive to incremental changes in acute hypertonic dehydration, however, the misclassified outcomes for Usg and U(osm) raise concerns. Research focused on elucidating the factors affecting accurate assessment of hydration status appears warranted.

Cross-validation of the NCAA method to predict body fat for minimum weight in collegiate wrestlers.

OBJECTIVE: In 1998, the National Collegiate Athletic Association (NCAA) adopted a new rule that required minimum weight testing for collegiate wrestlers. The objective of the study was to cross-validate the method used by the NCAA to estimate minimum weight in collegiate wrestlers. DESIGN: The NCAA skinfold equation was cross-validated against a criterion value from hydrostatic weighing (HW). SETTING The subjects were tested at the Universities of Wisconsin and Iowa. SUBJECTS: A sample of 93 college wrestlers from the Universities of Wisconsin and Iowa (mean +/- SD; age = 20.20 +/- 1.67 years, height = 171.98 +/- 6.63 cm, weight = 74.44 +/- 11.48 kg) were studied. OUTCOME MEASURES: Cross-validation included analysis of the standard error of estimate (SEE), total error (TE), and residual plots. RESULTS: The mean body fat from the NCAA prediction (10.61 +/- 3.58%) was not significantly different than HW (9.70 +/- 3.95%). The SEE was low (2.32%), and the TE was low (2.49%). The difference in methods was related to the size of the HW value. The residual plot (y = -0.26x + 3.45, R(2) = 0.198) suggests that fat is overestimated in the leaner wrestlers and underestimated in fatter wrestlers. CONCLUSION: The authors found the NCAA method to be a valid predictor of body fat in this sample of 93 collegiate wrestlers under the conditions of the study. Although some bias was seen across the range of fatness, these data support the NCAA method to estimate body fat in college wrestlers for establishment of minimum weight.