This study was designed to estimate the prevalence of hyposomatomedinemia and hypogonadism in an inpatient rehabilitation unit. The authors studied healthy young men (HOM) ages 20-29 years (n=33); healthy old men (HOM) ages 59-98 years (n=27), and elderly men in an inpatient rehabilitation unit (ERM) ages 58-95 years (n=42). Serum concentrations of insulin-like growth factor (IGF-I), total testosterone (TT), and free testosterone (FT) were measured. A low IGF-I level (below the lower 2.5 percentile of HYM) occurred in 85% of the HOM and in 62.5% of the ERM. When a low IGF-I was defined as a value below the 2.5 percentile of the HOM, the prevalence in ERM was 6.2%. A low TT level (below the lower 2.5 percentile of the HOM) occurred in 78% of the HOM and in 90% of the ERM. Low TT, defined as a value below the lower 2.5 percentile of the HOM, occurred in 22% of the ERM. The results with FT were similar. In neither HOM nor ERM was IGF-I significantly correlated to TT and FT. A large percentage of HOM and ERM have severe hypogonadism (TT<193 ng/mL) as compared with HOM. The ERM had a higher prevalence of severe hypogonadism as compared with the HOM.

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Abstract-The goals of this study were to describe clinical practice patterns associated with the Veterans Health Administration's (VHA's) Comprehensive Traumatic Brain Injury Evaluation (CTBIE) and determine whether practice patterns vary by patient, provider, or facility characteristics. Veterans (N = 614) who had initial healthcare visits between 2008 and 2011 and who had previously completed the VHA's traumatic brain injury (TBI) screen and subsequent CTBIE were drawn from a national database. Participants were primarily male (95%) with a mean age of 29.8 yr (standard deviation = 8). Chart reviews were conducted on a random sample of charts with completed CTBIEs from 21 sites. Using a cross-sectional design, patientand facility-specific variables were investigated as potential predictors of practice variation. During the study period, 79% of patients in this national sample were screened within 1 d of their initial healthcare visit and 65% were evaluated via CTBIE within 30 d of screening. Provider and participant characteristics were generally not associated with timeliness. The CTBIE was completed by individuals versus teams at comparable rates. Much of what occurred during the evaluation, beyond TBI-specific procedures, were medical assessments, such as review of medications and other substances.