Search PubMed⌕ Search

Biomedical subjects

M Fogelholm

Publications and source records attributed to M Fogelholm.

At least 37 records · Page 2Linked to original sources
PubMed1999

Parent-child relationship of physical activity patterns and obesity.

OBJECTIVE: To study differences in physical activity between normal-weight and obese children, as well as parent-child associations of obesity and physical activity. DESIGN: Cross-sectional study. SUBJECTS: 129 obese children (67 girls and 62 boys), 142 normal-weight controls (81 boys and 61 girls), and mothers (n = 245) and fathers (n = 222) of the children. METHODS: Physical activity was assessed by a 3-day physical activity record (children and parents), by a questionnaire (children), and by one question on habitual physical activity (parents). The data were analysed by stepwise linear and logistic regressions. Obesity was assessed from relative weight (children) and BMI (parents). RESULTS: Parent inactivity was a strong and positive predictor of child inactivity (beta-coefficients 0.25 and 0.16, P<0.001, for mother and father inactivity, respectively). Scores of parent activity were somewhat weaker predictors of child vigorous activity hours and total physical activity level (beta-coefficients 0.13-0.25, P = 0.003-0.08). Child obesity was negatively associated with child habitual physical activity (odds ratio 0.88, P<0.001). In addition, parent obesity (body mass index > or =30 kg/m2) was another strong predictor of child obesity (odds ratio 2.38-3.50, P<0.002). CONCLUSIONS: The present study underscores the parents' role in childhood activity patterns and obesity. A novel finding was that the parent-child relationship of inactivity appeared to be stronger than that of vigorous activity. Hence, parents who want to reduce their children's inactivity may have to pay attention to their own lifestyle.

Adult↗
PubMed1999

Factors affecting the relation between heart rate and energy expenditure during exercise.

This study evaluated the ability to use the relationship between heart rate (HR) and oxygen uptake (VO2) to estimate energy expenditure during physical activity (AEE). General prediction equations were established based on the individual relations between HR and AEE. Forty-two women, (mean age 38.1 [SD 9.8] years, BMI 23.9 [SD 4.4]), and 45 men (40.3 [SD 9.2] years, BMI 24.7 [SD 2.9]), carried out two incremental tests, one with a cycle ergometer and another on a treadmill. Subjects also performed a 10 minute steady-state exercise, cycling and walking. Respiratory gases were obtained from indirect calorimetry. AEE was calculated from VO2 and carbon dioxide production (VCO2). The predicted AEE was compared with the AEE measured during the steady-state exercise. Using the generalised linear model, two alternative models were found to predict AEE and HR. The first showed a three-way interaction between HR, body weight and gender (p = 0.022) and also between HR age and gender (p=0.083). The second produced a three-way interaction between HR, body weight and gender (p=0.057). For cycling and walking, respectively, the predicted AEE overestimated the actual AEE by 17.7 (SD 23.2)% and 6.2 (SD 19.3)% in the first model and by 17.9 (SD 22.7)% and 6.6 (SD 19.8)% in the second during the steady-state exercise. It was concluded that at least gender and body weight should be included when HR is used to predict AEE.

Adult↗
PubMed1999

Weight and diet concerns in Finnish female and male athletes.

UNLABELLED: PURPOSES AND METHODS: Factors related to eating disorders were studied in five groups of female (N = 173) and male (N = 190) athletes, and in female (N = 79) and male (N = 61) controls. Factors associated with menstrual status were also examined. RESULTS: The sum of drive for thinness and body dissatisfaction subscales in the Eating Disorders Inventory was higher (P < 0.05) in female controls (median: 5; 25th and 75th percentiles: 1 and 14) than in endurance athletes (0; 0 and 2). The male groups did not differ from each other (P = 0.08) or from female subjects (P = 0.62). The preferred weight loss in the female controls (-4.0 kg; -6.2 and -2.0) was larger (P < 0.05) than in most athletic groups. Males, on average, did not want to lose weight (different from females, P < 0.001). The prevalence of weight reduction attempts (85%) in female weight-class athletes was higher (P < 0.05) compared with endurance and ballgame athletes and the controls (29-58%). In males, the frequency (93%) of weight reduction attempts was also highest in the weight-class athletes (P < 0.05). The prevalence of menstrual disturbances was 27-37% in aesthetic, endurance, and weight-class athletes, and 5% in controls (P = 0.06). CONCLUSIONS: The results confirmed that the risk for eating disorders is dependent on the type of sport. The claim that some female athlete groups are at greater risk than controls did not receive evidence.

Adolescent↗
PubMed1999

Physical activity in the prevention and treatment of other morbid conditions and impairments associated with obesity: current evidence and research issues.

PURPOSE: To evaluate the current status of knowledge concerning the effects of physical activity in the treatment and prevention of obesity- related problems, including cancers of the colon, breast, uterus, and prostate; gallstones; osteoarthritis; back pain; sleep apnea; reproductive abnormalities; and impaired health-related quality of life. DESIGN: A Medline literature search on the effects of physical activity in the above conditions was conducted. Only studies with some measure of weight and a description of the type of physical activity were included. RESULTS: No controlled randomized trials of exercise in the treatment of any of the studied conditions in obese patients were identified. Most of the epidemiologic studies reviewed were beset with severe methodological weaknesses. Most of the 18 studies on physical activity and colon cancer risk showed a protective effect that in some studies appeared to be greater than expected by weight loss alone. Some but not all studies of hormone-dependent cancers and gallstones showed a protective effect for physical activity. There were insufficient data on the role of exercise for the other morbid conditions studied. CONCLUSION: The scarce data available on the role of physical activity in the prevention of obesity-related chronic conditions listed above suggest a protective role that needs to be examined further in studies with improved methodologies. Well-designed intervention trials are needed to assess the role of physical activity in the treatment and long-term outcome of obese patients with these co-morbid conditions.

Back Pain↗
PubMed1999

Increased extracellular water compartment, relative to intracellular water compartment, after weight reduction.

The hydration of fat free mass (FFM) and extracellular (ECW) and intracellular water (ICW) compartments were studied in 30 obese premenopausal women before and after a 3-mo weight-reduction program and again after a 9-mo weight-maintenance program. Body fat was determined by a four-compartment model. Total body water and ECW were determined by deuterium dilution and bromide dilution, respectively. After the weight-reduction period, mean weight loss was 12.8 kg, and body fat was reduced on average by 10.9 kg. During weight maintenance, changes in body mass and body fat were not significant. Before weight reduction, mean ECW/ICW ratio was relatively high (0.78 +/- 0.10). During the the study, total body water and ICW did not change significantly. ECW did not change significantly after weight reduction, but 12 mo after the start ECW was significantly increased by 1 liter. The ECW/ICW ratio increased to 0.87 +/- 0.12 (month 12). The hydration of the FFM increased from 74 +/- 1 to 77 +/- 2% during the weight reduction and remained elevated during weight maintenance. In conclusion, the ECW/ICW ratio and the hydration of the FFM, did not normalize during weight reduction and weight maintenance.

Adipose Tissue↗
PubMed1998

Assessment of energy expenditure in overweight women.

PURPOSE: To compare field measures of average daily energy expenditure (ADEE) against criterion data by the doubly labeled water method (DLW) in overweight women. METHODS: The subject were 20 overweight (BMI 29.9 +a- 3.0 kg.m-2) premenopausal women. Energy expenditure was measured by DLW and by the factorial method (activity diary, two techniques differing by method to obtain resting energy expenditure, REE), heart-rate monitoring (HR, two techniques differing by the FLEX-point to discriminate sedentary and activity HR), accelerometer, and pedometer. RESULTS: The ADEE(DLW) was 10.26 +a- 1.1 MJ.d-1. The mean bias (ADEE by the alternative minus ADEE(DLW) was smallest for the accelerometer (+ 0.08 +a- 1.63 MJ) and HR-FLEX10 (+ 0.11 +a- 1.67 MJ). The HR-FLEX(0) technique (lower FLEX-point) overestimated ADEE by + 1.18 (+a- 1.97 MJ). However, the random error (SD of bias) was smaller for both factorial techniques (REE measured: -0.48 +2- 0.81 MJ; REE calculated from the WHO equation: -0.22 +2- 0.88 MJ). CONCLUSION: The results show that simple factorial methods may assess ADEE with small random errors in population with a rather narrow range of physical activity. The accelerometer and HR with the higher FLEX-point have comparable results with smaller bias but larger random error compared with the factorial techniques.

Adult↗
PubMed1998

Additive effects of the mutations in the beta3-adrenergic receptor and uncoupling protein-1 genes on weight loss and weight maintenance in Finnish women.

This study examined whether the Trp64Arg mutation in the beta3-adrenergic receptor (beta3AR) and the A-->G mutation in the uncoupling protein-1 (UCP-1) genes have associations with weight loss and subsequent weight maintenance. Seventy-seven obese (body mass index range, 29-46 kg/m2), clinically healthy, premenopausal women were studied. A 12-wk weight reduction by very low calorie diet (VLCD) was followed by a 40-wk weight maintenance phase. The subjects were divided into four groups according to their beta3AR and UCP-1 genotype: no mutation (control; n=37), only Trp64Arg mutation in the beta3AR gene (n=12), only A-->G mutation in the UCP-1 gene (n=23), and both mutations (n=5). Subjects with both mutations had a lower weight reduction during VLCD than the controls [-10.5+/-0.6 (+/-SEM) vs. -14.0+/-0.5 kg; P=0.051, by ANOVA]. During the maintenance phase, weight in subjects with both mutations increased by 5.8+/-1.5 kg, but remained unchanged in the controls (-0.5+/-0.8 kg; P=0.041). The changes in weight in subjects with only one of the mutation were close to the results in the controls. Resting energy expenditure, adjusted for fat mass, fat-free mass, and maximal aerobic power, did not change differently between the groups throughout the study. The results suggest that a combination of the Trp64Arg mutation in the beta3AR and the A-->G mutation in the UCP-1 genes may be associated with faster weight gain after a VLCD.

Adult↗
PubMed1997

Association between weight cycling history and bone mineral density in premenopausal women.

The hypothesis that a history of one or more weight reductions and regains (weight cycling) is associated with lower site-specific bone mineral density (BMD) was examined in 169 premenopausal women, aged 29-46 years. Data on the previous 10-years' weight cycling history, present weight-bearing physical exercise, number of deliveries, present use of contraceptive pills or hormone-releasing coils, age at menarche and present menstrual status were collected by a self-administered questionnaire. Dietary intake was calculated from food records. The areal BMD (g/cm2) was measured with dual-energy X-ray absorptiometry (Norland XR-26). The lumbar spine (L2-4) BMD, adjusted to weight and age at menarche (ANCOVA), was 0.062 g/cm2 (95% confidence interval: 0.015 to 0.011 g/cm2; p = 0.01) higher in the non-cyclers (n = 68) than in subjects with reported weight-cycling history (n = 101). The corresponding difference for femoral neck BMD was 0.019 g/cm2 (-0.018 to 0.056; p = 0.30), for trochanter BMD 0.013 g/cm2 (-0.025 to 0.05 g/cm2; p = 0.50) and for distal radius BMD 0.022 g/cm2 (0.006 to 0.397 g/cm2; p = 0.008). A pairwise comparison of 34 weight-matched subjects (non-cycler vs cycler) gave similar BMD differences as found in the above (ANCOVA) analyses. The results suggest that weight cycling might be associated with lower spine and distal radius BMD.

Adult↗
PubMed1997

Alcohol beverage drinking, diet and body mass index in a cross-sectional survey.

OBJECTIVE: The study was carried out to determine the associations of alcohol beverage drinking with macronutrients, antioxidants, and body mass index. SETTING: Dietary subsample of the 1992 Finmonica cardiovascular risk factor survey in Finland; a cross-sectional study. SUBJECTS: 985 women and 863 men were drawn from the population register in the four monitoring areas. All subjects were 25-64 y of age. METHODS: The mailed questionnaire included questions covering socioeconomic factors, physical activity, smoking, and alcohol consumption. The diet was assessed using a three-day food record. RESULTS: The dietary differences between abstainers and alcohol consumers were more significant than between consumers of different alcoholic beverages. Among drinkers, fat intake as a percentage of energy was higher and carbohydrate intake was lower than among abstainers. Those who preferred wine, however, had the highest vitamin C intake; female wine drinkers also had the highest carotenoid intake. With the exception of those who mainly preferred spirits, alcohol energy was not added to the diet but seemed to substitute food items both in men and women. Despite the similar total daily energy intakes, daily energy expenditure, and physical activity index, male drinkers were leaner than abstainers. In women, the proportion of underreporters of energy intake increased with increasing alcohol consumption, and the association between alcohol and body mass index was similar to that in men after the exclusion of underreporters. CONCLUSIONS: Alcohol consumers were leaner than abstainers, and wine drinkers in particular had more antioxidants in their diet.

Adult↗
PubMed1997

Comparison of body composition methods: a literature analysis.

OBJECTIVE: To examine the comparability of different methods to assess percentage body fat (BF%) against underwater weighing (UWW). DESIGN: A meta-analysis on 54 papers, published in 1985-96, on healthy, adult Caucasians. METHODS: The mean BF% from different studies were treated as single data points. In addition to UWW, the studies included one or more of the following methods: 3- or 4-component model, dual-energy X-ray absorptiometry (DXA), dual-energy photon absorptiometry, isotope dilution, bioimpedance (BIA), skinfolds or near-infrared interactance (NIR). Within each of the methods, the analyses were done separately for different mathematical functions, techniques or instruments. MAIN OUTCOME MEASURES: Bias (mean difference) and error (s.d. of difference) between BF% measured by UWW and the other methods. RESULTS: The 4-component model gave 0.6 (95% confidence interval for the mean, CI: 0.1 to 1.2) BF% higher results than UWW. Also the 3-component model with body density and total body water (+1.4 BF%, 95% CI: +0.3 to +2.6), deuterium dilution (+1.5 BF%, 95% CI: +0.7 to +2.3), DXA by Norland (+7.2 BF%, 95% CI: 2.6 to 11.8) and BIA by Lukaski et al. (+2.0 BF%, 95% CI: 0.2 to 3.8) overestimated BF%, whereas BIA by Valhalla Scientific (-2.6 BF%, 95% CI: -4.5 to -0.6) and skinfold equations by Jackson et al. (-1.20, 95% CI: -2.3 to -0.1) showed a relative underestimation. The mean bias for the skinfold equation by Durnin & Womersley, against UWW, was 0.0 BF% (95% CI: -1.3 to 1.3). The correlation between the size of measurement and the mean difference was significant for only NIR (r = -0.77, P = 0.003). CONCLUSIONS: The difference between any method and UWW is dependent on the study. However, some methods have a systematical tendency for relative over- or underestimation of BF%.

Absorptiometry, Photon↗
PubMed1996

Amenorrhea in ballet dancers in the Netherlands.

The prevalence of amenorrhea was studied among 113 professional and student ballet dancers in the Netherlands (mean age 23.3 yr, SD 4.8). Sixty-one dancers not on oral contraceptives were included in the subsequent analyses. Six cases (prevalence 9.8 percent, 95 percent confidence interval: 2.4-17.2) with secondary amenorrhea (< or = 4 cycles per year; previous menstruation > or = 3 months prior to the study; menarche > or = 1 yr prior to the study) were found. Two dancers had primary amenorrhea (no menarche at the age of > or = 16). There was a negative correlation between the age of menarche and the number of menstrual cycles during the 12 months preceding the study (r = -0.46, P = 0.001). Body composition (four-compartment model), amount of dancing (recorded), resting energy expenditure (ventilated hood), dietary intake (recorded), and indices of eating disorders (Eating Disorders Inventory, EDI) were studied in 15 of the dancers, 5 amenorrheic and 10 eumenorrheic. No significant differences were found between the amenorrheic and eumenorrheic dancers. An explanation for the lower prevalence of amenorrhea in ballet dancers in the Netherlands, compared with U.S. dancers, was not obvious. Relatively low EDI scores (25.8, SD 14.5) in a subsample of 24 dancers could indicate less rigid emphasis on leanness and dieting.

Adult↗
PubMed1996

Total and occupationally active life expectancies in relation to social class and marital status in men classified as healthy at 20 in Finland.

STUDY OBJECTIVE: To study differences in total life expectancy and in occupationally active life expectancy in relation to social class and marital status in men classified as healthy as young adults. DESIGN: Historical cohort study. SETTING: Finland. PARTICIPANTS: Altogether 1662 men classified as completely healthy at the time of induction to military service (mean birth year 1923), who had been selected as referents for a study of former athletes. Mean follow up time was 46 years. MEASUREMENTS: Vital status was determined by follow up through local parish data up to 1990. Mortality data were obtained from the Cause of Death bureau of the Central Statistical Office of Finland. Occurrence of work disability was assessed from nationwide disability pension register data. Mean total life expectancy and mean occupationally active life expectancy (end points disability pension or death before age 65 years) were estimated. Social class was based on the major lifetime occupation, while marital status was classified as "never married" or "ever married" at the end of follow up. MAIN RESULTS: Mean total life expectancy was highest among executives and managers (73.2 (95% confidence interval (CI): 70.3, 76.1) years), next highest in clerical (white collar) workers (72.0 (70.0, 74.1) years), and lowest in unskilled blue collar workers (63.65 (61.1, 66.2) years). Skilled workers and farmers were intermediate. For the occupationally active life expectancy estimates, a similar gradient was observed: highest for executives (61.9 (60.7, 63.1) years) and lowest for the unskilled (52.2 (50.2, 54.2) years). The ratio of occupationally active life expectancy to total life expectancy was highest for executives (85%) and lowest for farmers (81%) and unskilled workers (82%). CONCLUSIONS: The social class gradient known to exist for mortality is also present for occupational disability. Social class and marital status differences in mortality are already evident in early adulthood and continue into old age. Those with the highest life expectancy also have the largest proportion of their life span free of occupationally incapacitating disability.

Adult↗
PubMed1996

Determinants of energy balance and overweight in Finland 1982 and 1992.

OBJECTIVE: To study the prevalence of overweight (BMI > 27 kg/m2) and major life-style determinants of energy balance in Finland, in 1982 and 1992. DESIGN: Cross-sectional study. SUBJECTS: 640 men and 677 women in 1982, and 664 men and 765 women 1992. MEASUREMENTS: BMI, dietary intake (3 d food record), physical activity and energy expenditure (self-administered questionnaire), data on smoking and educational status. RESULTS: The prevalence of overweight men was 39% in 1982 and 43% in 1992, and of women 33% and 34%, respectively. In 1992, the reported daily energy intake was 1203 kJ lower in men, and 711 kJ lower in women, compared with 1982 (P < 0.001). When suspected underreporters (energy intake less than 1.28 x BMR) were excluded, the decrease in reported energy intake was only 519 kJ (men) and 347 kJ (women) (P < 0.01). In 1992, the total physical activity level was 3.0% lower in men (P = 0.002), but only 0.6% lower in women (P = 0.18). Between 1982 and 1992, energy expenditure during work (P < 0.03) and during moving to and from work (P < 0.002) decreased. In contrast, energy expenditure during leisure-time exercise activity increased in men (+113 kJ/d) and in women (+146 kJ/d) (P < 0.001). CONCLUSION: Underreporting may explain a major part of the observed decrease in reported energy intake in 1992. The decreased energy expenditure during work was not counterbalanced by increased leisure-time physical exercise.

Adult↗
PubMed1995

Ubiquinone supplementation and exercise capacity in trained young and older men.

It has been suggested that ubiquinone improves exercise performance and antioxidant capacity. We studied the effects of ubiquinone supplementation (120 mg.day-1 for 6 weeks) on aerobic capacity and lipid peroxidation during exercise in 11 young (aged 22-38 years) and 8 older (aged 60-74 years), trained men. The cross-over study was double-blind and placebo-controlled. Serum ubiquinone concentration increased after supplementation (P < 0.0001 for treatment) in both age groups. The maximal oxygen uptake (VO2max) was measured using a direct incremental ergometer test. In the young subjects, the VO2max after placebo and ubiquinone treatment was 58.5 (95% confidence interval: 53.0-64.0) and 59.0 ml.min-1.kg-1 (52.2-66.8), respectively. The corresponding results in the older subjects were: 37.2 (31.7-42.7) and 33.7 ml.min-1.kg-1 (26.2-41.7) (P < 0.0001 for age group, P > 0.05 for treatment). In a prolonged test (60-min submaximal, then incremental load until exhaustion) time to exhaustion was longer after the placebo [young men: 85.7 (82.4-89.0), older men: 82.9 min (75.8-89.9)] than after ubiquinone [young men: 82.1 (78.5-85.8), older men: 77.2 min (70.1-83.7); P = 0.0003 for treatment]. Neither ubiquinone supplementation nor exercise affected serum malondialdehyde concentration. Oral ubiquinone was ineffective as an ergogenic aid in both the young and older, trained men.

Adult↗
PubMed1995

Physical activity, body composition and bone density in ballet dancers.

The main purpose of the present study was to examine factors that affect bone mineral density (BMD) in female ballet dancers. Training history, Ca intake, body composition, total body BMD (TBMD) and site-specific BMD, and bone mineral content were described in twenty-four female ballet dancers (mean age 22.6 (SD 4.5) years). Training history was determined by questionnaires, Ca intake by 7 d dietary record, BMD and bone mineral content by dual-energy X-ray absorptiometry (DXA), total body water by 2H dilution, extracellular water by bromide dilution, body fat by underwater weighing (UWW; two-component model), DXA, and the four-component (4C) model. Dancers had a significantly lower body mass index (BMI 18.9 (SD 1.0) kg/m2) than controls (21.3 (SD 1.9) kg/m2), with significantly lower percentage body fat (17.4 (SD 3.9) v. 24.4 (SD 5.1)) but comparable fat-free mass. Mean TBMD (1.147 (SD 0.069) g/cm2) was significantly higher (6%) compared with that of a reference population. These high values could be attributed to the high BMD of legs and pelvis, the weight-bearing sites of the dancer's body. No relationship was found between age, start of ballet classes, period (years) of dancing, Ca intake, and BMD (total and site-specific). However, TBMD was positively related to BMI, and negatively related to the age of menarche. BMD of the legs was significantly related to BMI, and negatively related to the age of menarche. BMD of the legs was significantly related to daily period (h) of training. Depending on the method used the percentage body fat ranged from 16.4 (by DXA) to 18.3 by the 4C model. These differences were significantly related to the TBMD. Percentage body fat by the different methods was not significantly different, except for DXA and 4C model. The present study showed that, despite the factors that have a negative effect on BMD, such as low body mass and late menarche, BMD in female ballet dancers was relatively high. These high values were probably caused by high levels of weight-bearing physical activity.

Absorptiometry, Photon↗
PubMed1995

Chronic oral lactate supplementation does not affect lactate disappearance from blood after exercise.

This study tested the hypothesis that a 3-week oral lactate supplementation affects postexercise blood lactate disappearance in untrained male subjects. Fifteen men were randomly assigned to either a lactate supplementation (n = 8) or a placebo (n = 7) treatment. During the treatment period they drank an oral lactate or a maltodextrin (placebo) supplement twice a day. The lactate drink contained 10 g of lactate as calcium, sodium, and potassium salts. Blood lactate concentrations were studied before, during, and immediately after three exercise tests, both pre- and posttreatment. Peak lactate values for placebo (PL) or lactate (L) treatment groups during different tests were as follows: Test 1 PL, 13.49 +/- 3.71; L, 13.70 +/- 1.90; Test 2 PL, 12.64 +/- 2.32; L, 12.00 +/- 2.23; Test 3 PL, 12.29 +/- 2.92; L, 11.35 +/- 1.38 and were reached 3 min postexercise. The decrease in blood lactate during the long (30- to 45-min) recovery periods amounted to / 10 mmol/L. Blood lactate changes were highly reproducible. However, a 3-week oral lactate supplementation did not result in differences in lactate disappearance. This study does not support the hypothesis that regular oral lactate intake at rest enhances the removal of lactate during and following exercise, that is, not with the given lactate load and supplementation period.

Administration, Oral↗
PubMed1995

Dietary intake and nutritional status of athletic and nonathletic children in early puberty.

Dietary intakes, trace element status, and anthropometric measures were studied in 12- to 13-year-old boys (n = 49) playing ice hockey (AB) and in 11- to 12-year-old girls who were gymnasts, figure skaters, and runners (AG; n = 43). Thirty-five boys (CB) and 53 girls (CG) not involved in supervised sports were controls. After adjustment for sexual maturation, ABs had larger upper arm muscle circumference than CBs. The sum of four skinfolds was smaller in AGs than in CGs. The intake of energy and all micronutrients examined was higher in ABs than in CBs. Micronutrient intakes were not different between AGs and CGs. Compared to CBs, serum ferritin and copper concentrations were lower, but serum zinc concentration was higher in ABs. No differences in trace element status were found between AGs and CGs. Blood investigations did not indicate inadequate trace element status in any of the groups studied.

Adolescent↗