Changes in VA hospital use 1980-1990.

During the 1980s several changes occurred within and outside the Veterans Affairs medical system which may have affected levels of Veterans Affairs (VA) hospital use. We performed a secondary analysis of the 1980-1990 national VA hospital discharge database and Veteran Population Files to examine trends in VA hospital use and to assess effects of the aging of the veteran population. Between 1980 and 1990 discharges increased by 7% despite a 6% drop in the number of veterans. Overall the crude discharge rate increased by 13% and the user rate by 1%. Most of the change was attributable to the fact that as the decade progressed, the veteran population was comprised of proportionately older veterans, who are higher users of hospital care than younger veterans. The 11% increase in the multiple stay ratio was not attributable to aging. Examination of age-specific utilization rates showed that veterans younger than age 45 had consistent increases in use, whereas use by older veterans declined. Our findings indicate that change in the age composition of the veteran population is responsible for some but not all of the increase in VA hospital use in the last decade. The increase in use by young veterans may reflect increasing barriers to access to non-VA care. Declines in use by older veterans may indicate that VA has been successful in shifting the locus of care from the hospital to the ambulatory and long-term care settings.

The adolescent basketball player.

Adolescent basketball players can be viewed in two ways, as a unique population requiring special attention for their unique problems or as a similar group sharing the same problems as their adult counterparts. Attention should be paid to issues related to adolescence in general including changes in body size, growth of the musculoskeletal system, and hormonal changes that contribute to changes in behavior, emotions, and maturity. Attention to the particular needs of the adolescent basketball player may help prevent problems or lead to early recognition and intervention.

Dietary prevention and treatment of disease.

Diet is a major factor in five of the 10 leading causes of death in the United States and is a contributing factor in many other diseases and health conditions. Certain diseases can be prevented and general health can be maintained or improved if patients are willing to follow advice about nutrition. Hence, nutrition-related consideration of fiber, cholesterol, carbohydrates and energy should be integral to the management of health conditions.

Substance abuse.

The three types of drugs commonly used in sports--therapeutic drugs, performance-enhancing drugs, and recreational drugs--have been discussed and presented in a way that should be helpful to health care providers dealing with athletes. The goal of this article has been not only to present information concerning drugs but also to raise the awareness level so that abuse of all types of drugs will be considered by athletic trainers, physicians, and health care providers when they deal with athletes. The role of the physician in the area of drug abuse is no different than the physician's role in dealing with any health problem, diagnosis, and management. The responsibility of the physician who deals with athletes always has been, is, and always will be the health and safety of the athlete.

Age-specific death rates with tobacco smoking and occupational activity: sensitivity to sample length, functional form, and unobserved frailty.

In this article, we estimate accelerated time-to-failure and proportional-hazard functions with about 100,000 members of the Dorn sample, finding greater hazards associated with smoking and some dependence on occupational variables that measure risk and physical activity. We answer three questions: (1) How sensitive are the estimates to sample length, using monthly data for the periods 1954-1969 and 1954-1980? The results differ somewhat between these sample periods. (2) How sensitive are the estimates to alternative functions for the hazard? Within a given time period, the estimates are fairly robust to specification changes in the distribution of the hazard in the accelerated time-to-failure models. (3) How sensitive are the estimates to alternative controls for unobserved frailty? Within a given sample period, the estimates are fairly robust to the allowance for parametric or nonparametric heterogeneity in the proportional-hazard models.

The incidence of Legionella pneumophila as the cause of acute ambulatory lower respiratory tract infection.

Seventy-nine ambulatory patients with acute lower respiratory tract infection were evaluated for Legionella pneumophila by acute and convalescent antibody titers. None of the patients met the traditional criteria for the diagnosis of acute infection caused by Legionella pneumophila. Currently accepted criteria for diagnosing legionellosis by serologic means may or may not be applicable to mild respiratory tract infections.