Anticipatory Guidance for Long-Distance Running in Young Athletes.

More young children are participating in endurance running events such as full and half marathons, and the safety of these events for children has been heavily debated. There is a paucity of evidence on either side of the debate. However, overuse injuries, stress fractures, as well as the potential for psychologic burnout are legitimate concerns. Parents who are seeking advice from pediatricians about child participation in these endurance events should be made aware of these risks. Young children may participate in endurance running events under close supervision from health professionals, coaches, and parents, with full medical evaluation before initiation of training, throughout training, as well as 6 to 12 months post-race. Special attention should be made to the psychologic well-being of the child, with the participation in running being child-driven, not parent- or coach-driven, and emphasis on enjoyment and fitness, not competition.

Military health care utilization by teens and young adults.

OBJECTIVES: Adolescents and young adults are frequently uninsured (9.0% and 26.4%). Under the Affordable Care Act, the impact of insuring this population on health care utilization is unclear. We examined insurance records from >3.5 million non-pregnancy-related primary care visits in the Military Health System to describe health care utilization patterns among 467,099 non-active duty patients, aged 12 to 22, with access to free health care. METHODS: We described association of age and gender with primary care utilization rates, clinic type, and primary and secondary diagnoses. RESULTS: Adolescents and young adults were seen for 2.63 primary care visits per year. Use of Pediatric Clinics declined with age (51.6% to 1.8%) and increased for Family Medicine (45.5% to 91.1%). The top 3 diagnostic groups in our study were health maintenance (18.3%), health evaluation (17.3%), and respiratory/ear, nose, and throat (15.1%). Age-by-gender interactions had a significant association with health care utilization rates and diagnoses at primary care appointments. For example, the percent of all appointments accounted for by musculoskeletal injuries increased significantly (P < .001) with age for males (10.6%, 12-14 years; 12.8%, 15-18 years; 15.2%, 19-22 years) and decreased for females (10.3%, 9.2%, 7.5%). CONCLUSIONS: Unlike previous studies of adolescents and young adults, we show that this population, especially female young adults, does use health care when it is available and largely free. Extrapolating from our Military Health System data, we expect implementation of the Affordable Care Act will result in an increased demand for health care, particularly in the areas of reproductive health care, respiratory/ear, nose, and throat issues, and routine health maintenance.

Multidisciplinary intervention with sibutramine: assessing successful weight loss predictors in military adolescent dependents.

OBJECTIVES: Assess body mass index (BMI) reduction through a multidisciplinary intervention with sibutramine in adolescents of military parents and examine characteristics and behavioral traits as predictors of successful weight loss. METHODS: A prospective study where participants received sibutramine daily for 6 months. Adolescents ages 12 to 18 with BMI-for-age and sex greater than 95 percentile and good health were enrolled. Outcome variables are BMI, biochemical indices, and clinical measurements. Predictor variables are participant demographics, family history, lifestyle changes, and behavioral traits assessed with behavioral assessment for children. RESULTS: One hundred participants were recruited with 81% completion. In those participants who completed the 6-month intervention, a mean participant BMI reduction of 3.1 kg/m2 (-9.3%) (p < 0.001; 95% CI: -10.5% to -7.9%) was obtained with 79% successfully meeting the weight loss goal. Sibutramine dose was increased from 10 to 15 mg at 3 months for participant with <2.5% BMI reduction from baseline. Sibutramine dose at 3 months (p < 0.001) and participants perception of relationship with parents (p = 0.05) were statistically significant predictors of successful weight loss (> or =10% reduction in BMI). CONCLUSIONS: Sibutramine was effective at promoting minimum beneficial BMI reduction of 5% in adolescents with service-connected parents; however, increasing dosage at 3 months did not improve the likelihood of being successful.

Environmental enrichment reduces neuronal intranuclear inclusion load but has no effect on messenger RNA expression in a mouse model of Huntington disease.

Huntington disease (HD) is a fatal neurodegenerative disease with no effective treatment. In the R6/1 mouse model of HD, environmental enrichment delays the neurologic phenotype onset and prevents cerebral volume loss by unknown molecular mechanisms. We examined the effects of environmental enrichment on well-characterized neuropathological parameters in a mouse model of HD. We found a trend toward preservation of downregulated neurotransmitter receptors in striatum of environmentally enriched mice and assessed possible enrichment-related modifications in gene expression using microarrays. We observed similar gene expression changes in R6/1 and R6/2 transgenic mice but found no specific changes in enrichment-related microarray expression profiles in either transgenic or wild-type mice. Furthermore, specific corrections in transprotein-induced transcriptional dysregulation in R6/1 mice were not detected by microarray profiling. However, gene-specific analyses suggested that long-term environmental enrichment may beneficially modulate gene expression dysregulation. Finally, environmental enrichment significantly decreased neuronal intranuclear inclusion load, despite unaffected transgene expression levels. Thus, the therapeutic effects of environmental enrichment likely contribute to decreasing aggregated polyglutamine protein levels without exerting strong effects on gene expression.