Does Sports Medicine Fit in the New Health Care Market?

Physicians are being forced to compete for their share of a changing health care market. Two traditional concerns of sports medicine-fitness and preventive care-may help some physicians keep their practice healthy.

Out-of-wedlock births, premarital pregnancies and their effect on family formation and dissolution

The persistent rise in the proportion of firstborn babies conceived out of wedlock, which characterized the period from the 1950s to the early 1970s, has apparently abated, according to data analyzed from the June 1980 and June 1982 Current Population Surveys (CPS). Although the proportion increased from 16 percent of firstborn children among women 15 years and older in the 1950-1954 period to 34 percent in the 1970-1974 period, it subsequently declined to 31 percent in 1975-1979, and has remained at that level. Since 1970, approximately 68 percent of firstborn children among teenage women have been conceived outside of marriage, four times the level recorded during the same period among women aged 20 and older. In addition, more than 90 percent of firstborn babies among black teenagers have been conceived out of wedlock, compared with about 60 percent among white teenagers. Among women aged 20 and older, about 50 percent of firstborn babies of black mothers and approximately 13 percent of firstborn babies of white mothers have been conceived outside of marriage. Despite the recent overall stability in the proportion of first babies conceived out of wedlock, a notable decline has occurred in the likelihood of mothers to marry before the birth of the child. Between the 1950-1954 and the 1970-1974 periods, about 50 percent of all women who had an out-of-wedlock pregnancy married before the birth; this proportion has since fallen below 40 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathologic effects of fractionated fast neutrons or photons on the pancreas, pylorus and duodenum of dogs

Thirty-nine adult male Beagles received either fast neutron or photon irradiation to the right thorax to determine the relative biological effectiveness (RBE) of fast neutrons on normal pulmonary tissue. The right anterior abdomen was included in the field of radiation. Twenty-four dogs (six/group) received fast neutrons with an average energy of 15 MeV to total doses of 1000, 1500, 2250 or 3375 rad in four fractions per week for six weeks. Fifteen dogs received 3000, 4500 or 6750 rad of photons (five/group) in an identical fractionation pattern. All neutron irradiated dogs receiving 3375 and 2250 rad and one receiving 1500 rad developed clinical signs of pancreatic, hepatic and gastrointestinal disturbances. The liver enzymes of these dogs became elevated and they died or were euthanatized in extremis 47-367 days after irradiation. Only one 6750 rad photon dog developed similar signs and died 708 days post-irradiation. Five neutron and 10 photon exposed dogs died of other causes. Neutron-induced lesions in the stomach and duodenum included hemorrhages, erosions, ulcerations and fibrosis. Ulcers perforated the GI tract of five dogs. Pancreatic lesions included degranulation and necrosis of acinar cells, fibrosis ans atrophy. Islet cells were not obviously damaged. All lesions were associated with degenerative and occlusive vascular changes. The RBE of fast neutrons, assessed by clinical signs, gross and microscopic pathology, is approximately 3-4.5 for pancreas and about 4.5 for pylorus and duodenum.

Assessing cohort birth expectations data from the Current Population Survey, 1971-1981

Data from the fertility supplements to the Current Population Survey from 1971 to 1981 indicate that in the aggregate, the lifetime birth expectations of married women 18 to 39 years old in 1971 will closely approximate their completed cohort fertility. During this period, the youngest group of women, 18 to 24 years old, delayed their childbearing; their short-term expectations (1971-76) were not realized, but they made up enough births in the latter half of the decade to enable them to attain their lifetime birth expectations. In retrospect, the "failure" of birth expectations data to predict the "period" fertility downswing in the 1970s resulted not from poor predictions of married women, but rather from unanticipated marital and subsequent childbearing patterns of women who were single at the beginning of the decade. The authors conclude that birth expectations are useful predictors of completed cohort fertility, if adjustments are made to incorporate changes in the proportions married within the birth cohort.

RTOG Phase I study on fast neutron teletherapy for squamous cell carcinoma of the esophagus

From August, 1977, through January, 1981, the Radiation Therapy Oncology Group sponsored a Phase I study (RTOG 77-09) on the use of fast neutrons for treating inoperable squamous cell carcinomas of the esophagus. A total of 39 evaluable patients were treated with curative intent using either fast neutrons alone or in combination with low LET irradiation as part of a mixed beam fractionation scheme. Actuarial survival curves are presented for both the "neutrons alone" and the "mixed beam" treatment groups. There was no significant survival difference between these groups of patients. The projected survival at two years is less than 10%, which is comparable with megavoltage photon results for an unselected series of patients. The size of the primary lesion and the initial Karnofsky performance status were found to be the most important prognostic indications for prolonged survival. Sixteen of 39 patients were felt to have achieved local clearance of their tumor at some time during their follow-up with the median time until a local recurrence being 17 months. Treatment related complications and patterns of metastatic spread are discussed. In general, it appeared that the response of large tumors to neutron irradiation resulted in necrosis and fistula formation. In many cases this was accompanied by persistent/recurrent tumor within the high dose radiation volume.

Neoplasia in fast neutron-irradiated beagles

One hundred fifty-one beagle dogs were irradiated with either photons or fast neutrons (15 MeV) to one of three dose-limiting normal tissues--spinal cord, lung, or brain. The radiation was given in four fractions per week for 5 weeks (spinal cord), 6 weeks (lung), or 7 weeks (brain) to total doses encompassing those given clinically for cancer management. To date, no nonirradiated dogs or photon-irradiated dogs have developed any neoplasms. Seven dogs receiving fast neutrons have developed 9 neoplasms within the irradiated field. Of the neutron-irradiated dogs at risk, the incidence of neoplasia was 15%. The latent period for radiation-induced cancers has varied from 1 to 4 1/2 years at this time in the study.

Treatment experience: locally advanced sarcomas with 15 MeV fast neutrons

Experience with ten evaluable osseous sarcomas and ten evaluable advanced soft tissue sarcomas treated with neutrons of a mean neutron energy of 15 MeV are described. Neutron irradiation with or without conventional megavoltage radiotherapy is an effective modality in the treatment of these patients. No correlation between response rate and grade or whether fast neutrons alone or combined with megavoltage radiotherapy was noted. Those patients receiving a neutron dose of 2195 neutron plus gamma rads or greater all had a complete response.