The energy cost of horizontal walking and running in adolescents

PURPOSE: This study developed and cross-validated generalized equations for predicting VO2 (mL x kg(-1) x min(-1)) and caloric expenditure (kcal x kg(-1) x min(-1)) during horizontal walking and running in adolescents. METHODS: Subjects were 47 male and 35 female adolescent volunteers, ages 12-18. Each subject underwent a submaximal treadmill exercise test to determine VO2 at randomly selected walking and jogging speeds (67-215 m x min(-1)). Caloric expenditure was estimated from VO2 and RER. Multiple regression was used to develop prediction equations for estimating VO2 and caloric expenditure from a derivation sample of 77 random observations, both walking and running. RESULTS: The group relationship between running speed and energy cost in the derivation sample was linear, whereas the relationship between walking speed and energy cost was quadratic. Gender, age, and height each failed to account for significant additional variation in energy cost after speed and mode were considered. Skinfolds accounted for a small yet significant amount of additional variation in energy cost. The derived equations were cross-validated on a sample of 76 separate random observations. The cross-validation statistics are: for VO2, R = 0.95, error = 3.58 mL x kg(-1) x min(-1), and for caloric expenditure, R = 0.94, error = 0.019 kcal x kg(-1) x min(-1). Most selected adult equations consistently underestimated both VO2 and caloric expenditure in the cross-validation sample. CONCLUSIONS: These results suggest that in adolescents, within the range of speeds tested, the relationship between speed of movement and energy cost for running is linear, but for walking is curvilinear. Also, adult models for estimating VO2 or caloric expenditure do not account for the higher relative energy cost of walking and running in adolescents.     

Contraceptive use and pregnancy risk among U.S. high school students, 1991-2003

CONTEXT: Trends in teenagers' contraceptive use have received less attention than trends in adolescent sexual intercourse, despite the importance of contraceptive use to preventing teenage pregnancy. METHODS: Sexually active high school students' use of contraceptives and risk of pregnancy from 1991 to 2003 were examined using data from the national Youth Risk Behavior Survey and published contraceptive failure rates. Changes in pregnancy risk were assessed using weighted least-squares regression. RESULTS: Between 1991 and 2003, contraceptive use improved among sexually active U.S. high school students. Improvements among women included an increase in the proportion reporting condom use at last sex (from 38% to 58%) and declines in the proportions using withdrawal (from 19% to 11%) and no method (18% to 12%). Hormonal method use changed little, as a decline in pill use (from 25% to 20%) was offset by use of injectables (5% in 2003). Similar patterns were found among men. Women's risk of pregnancy declined 21% over the 12 years. The largest improvements in contraceptive use and pregnancy risk occurred among ninth graders, and whites and blacks. In 2003, 46% of pregnancy risk resulted from failure to use any method of contraception, and 54% resulted from contraceptive failure. CONCLUSIONS: Improvement in the use of contraceptives by sexually active high school students during the 1990s is encouraging. To sustain this trend, programs need to encourage contraceptive use among teenagers who do not use it and to stress consistent and correct use among those who do.     

Inhalation of ultrafine particles alters blood leukocyte expression of adhesion molecules in humans

Ultrafine particles (UFPs; aerodynamic diameter < 100 nm) may contribute to the respiratory and cardiovascular morbidity and mortality associated with particulate air pollution. We tested the hypothesis that inhalation of carbon UFPs has vascular effects in healthy and asthmatic subjects, detectable as alterations in blood leukocyte expression of adhesion molecules. Healthy subjects inhaled filtered air and freshly generated elemental carbon particles (count median diameter approximately 25nm, geometric standard deviation approximately 1.6), for 2 hr, in three separate protocols: 10 microg/m3 at rest, 10 and 25 microg/m3 with exercise, and 50 microg/m3 with exercise. In a fourth protocol, subjects with asthma inhaled air and 10 microg/m3 UFPs with exercise. Peripheral venous blood was obtained before and at intervals after exposure, and leukocyte expression of surface markers was quantitated using multiparameter flow cytometry. In healthy subjects, particle exposure with exercise reduced expression of adhesion molecules CD54 and CD18 on monocytes and CD18 and CD49d on granulocytes. There were also concentration-related reductions in blood monocytes, basophils, and eosinophils and increased lymphocyte expression of the activation marker CD25. In subjects with asthma, exposure with exercise to 10 microg/m3 UFPs reduced expression of CD11b on monocytes and eosinophils and CD54 on granulocytes. Particle exposure also reduced the percentage of CD4+ T cells, basophils, and eosinophils. Inhalation of elemental carbon UFPs alters peripheral blood leukocyte distribution and expression of adhesion molecules, in a pattern consistent with increased retention of leukocytes in the pulmonary vascular bed.     

Current comprehensive assessment and management of women at increased risk for breast cancer

The potential for reducing the risk of breast cancer through selective estrogen receptor modulators, aromatase inhibitors, and surgery has generated interest in the use of quantitative models of risk assessment. With the addition of ductal lavage cytology to traditional epidemiologic risk factors, a discovery of cellular atypia can result in refinement of assigned risk values, while simultaneously optimizing patient selection for selective estrogen receptor modulators utilization. In view of increasing complexity in this arena, a Risk Assessment Working Group was formed to outline management strategies for the patient at an elevated risk for the development of breast cancer. No longer a statistical exercise, quantitative risk assessment is part of basic breast care and comprehensive management includes a discussion of the following: ductal lavage for improved risk stratification, multiple options for risk reduction, and high risk surveillance strategies that might incorporate investigational imaging protocols.