H. Quan 1 , J.E. Arboleda-florez 2 , G.H. Fick 1 , H.L. Stuart 2 , E.J. Love 1 ; 1 University of Calgary, Calgary, Alberta; 2 Queen's University, Kingston, Ontario PURPOSE: Only a few small studies have explored the association between various physical illnesses and suicide in the elderly and they have produced inconsistent results. Thus, we undertook this larger study to more definitively assess the association between elderly suicide and physical illness. METHODS: This case-control study included all suicides (920 cases) and motor vehicle accident deaths (1,050 controls) for 1984 ± 95 in the Province of Alberta, Canada among Alberta residents aged 55 years and older. We reviewed Medical Examiner records and extracted sociodemographic information. Then, deterministic linkage was used to link subjects to the Alberta provincial health care registry to determine personal identifiers. Those identified in the registry (1766, 90%) were linked with hospital discharge and physician claims data. We extracted coded diagnoses for each subject in the two years prior to the date of suicide or accident. The accuracy of the administrative data diagnoses was assessed through patient chart review in a sub-set of the study population, revealing kappa values ranging from 0.70 for prostatic disorder to 1.0 for cancer. RESULTS: Compared to the motor vehicle accident victims, the elderly who committed suicide were more likely to be men (78.6% vs. 62.2%), aged 55 ± 64 years old (50.6% vs. 37.5%), unmarried (46.4% vs. 41.0%), white (96.4% vs. 91.7%), residents of high median income areas (43.7% vs. 26.9%) or urban areas (58.4% vs. 40.5%), and to have a history of depression (37.0% vs. 6.2%) or other psychiatric illnesses (57.1% vs. 26.0%). The two groups were similar in the proportion of unemployed (80.9% vs. 82.8% currently). When controlling for sociodemographic characteristics and psychiatric disorders, the elderly who committed suicide were more likely to have had cancer (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 1.16 ± 2.58) and prostatic disorders excluding prostate cancer (OR: 1.70, CI: 1.16 ± 2.49) than were motor vehicle accident victims. Among those who were married, chronic pulmonary disease was more frequent among the elderly who committed suicide than among motor vehicle accident victims (OR: 1.86, CI: 1.22 ± 2.83). Ischemic heart disease, cerebrovascular disease, peptic ulcer disease, and diabetes mellitus were not independently associated with elderly suicide. CONCLUSION: Cancer, chronic pulmonary disease, and prostatic disorders appear to be associated with suicide among the elderly. Physicians and other clinicians should consider assessment and monitoring of patients' suicidal tendencies when such conditions are present. PURPOSE: Hypothyroidism (HYPO) is associated with increased atherosclerosis in autopsy studies. Higher plasma homocysteine (Hcy) levels, even within the normal range, are an independent risk factor for cardiovascular disease. A few studies have shown that patients with HYPO have increased Hcy levels. Some have suggested that this may be due to the slightly increased creatinine (Cr) level in HYPO but other factors affecting Hcy status were not examined. Therefore, we assessed Hcy, vitamin and Cr levels together in patients with HYPO. Because little comparative information exists for patients with hyperthyroidism (HYPER) and none for patients with subclinical hypothyroidism (SC-HYPO), these conditions were also studied. METHODS: Hcy, thyroid stimulating hormone (TSH), free thyroxine (FT4), vitamin B12 (B12), folate and Cr levels were measured in 11 (2 men, 9 women), 10 (2 men, 8 women), and 19 (5 men, 14 women) patients with HYPO, SC-HYPO and HYPER respectively. RESULTS: Mean (SD) Hcy level was higher in HYPO than in HYPER (9.63.0 vs 8.42.7 "mol/l) but not significantly so (p = .26) and only 1 patient had an abnormal Hcy (normal in women = 4.4 ± 12.1 "mol/l). Hcy in SC-HYPO (10.32.2 "mol/l) was also higher than in HYPER (p = .055). Plasma Hcy did not correlate with either TSH or FT4 levels. Although Cr levels were higher in HYPO than in the other groups (p = .0003), the Cr level did not correlate with Hcy. On the other hand, folate levels were significantly lower in HYPO than in HYPER (9.26.0 vs 17.611.2 "g/l, p = .013); folate levels were also lower in SC-HYPO (8.9 3.2 "g/l; p = .005). The folate levels correlated inversely with Hcy levels in the entire population (p = .001) and within the HYPO group (p = .06). B12 levels showed no significant patterns in thyroid disease. CONCLUSION: Our data show that Hcy levels are higher in HYPO than in HYPER but not significantly so. While Cr levels were significantly higher in HYPO than in HYPER, our data suggest that Cr levels are not the major determinant of Hcy changes in thyroid disease. Instead, folate status appears to play an important role in thyroid disease that was not appreciated because vitamin and renal status had not been examined together until now. Finally, our data raise the possibility that early changes in Hcy levels similar to those in HYPO may appear in SC-HYPO. If confirmed by our therapeutic trials, these data may provide an additional reason for intervention in SC-HYPO to mitigate atherosclerotic risk. PURPOSE: Female patients are less likely to undergo cardiac procedures after a myocardial infarction (MI) than male patients. We examined the use of cardiac catheterization and coronary revascularization post-MI to determine whether sex disparities in procedure use were associated with physician sex or were more pronounced when a patient and physician were of different sexes. METHODS: We evaluated data from the Cooperative Cardiovascular Project, a sample of Medicare beneficiaries hospitalized for MI in 1994 and 1995. Patients age 65 years and older with a confirmed MI who presented directly to the hospital with no prior history of revascularization (n = 111,319) were linked with physician data provided by the American Medical Association and evaluated for the use of cardiac catheterization (CATH) and coronary revascularization (REVASC, by PTCA or CABG) within 60 days of admission for MI. Separate multivariable logistic regression analyses were employed to ascertain the influence of patient sex and physician sex for CATH and REVASC use adjusting for patient sociodemographic characteristics, illness severity, physician factors (specialty, age, race, practice type), and hospital characteristics. A patient sex/physician sex interaction term was incorporated in multivariable analysis in order to test whether differences in procedure use were greater when a patient and physician were of different sexes. RESULTS: Female patients were less likely to undergo CATH (39.4% vs. 52.1%, p = 0.001) and REVASC (25.8% vs. 36.7%, p = 0.001) than male patients, while patients treated by male physicians were more likely to undergo CATH (45.9% vs. 39.5%, p = 0.001) and REVASC (31.4% vs. 25.8%, p=0.001) than patients treated by female physicians. Female patients remained less likely to undergo CATH (odds ratio [OR]: 0.82, 95% confidence interval [CI] 0.80,0.85) and REVASC (OR 0.80, 95% CI 0.77,0.82) in multivariable analysis, regardless of the treating physician' s sex. In contrast, patients treated by male physicians were more likely to undergo CATH (OR 1.15, 95% CI 1.07,1.23) and REVASC (OR 1.14, 95% CI 1.06,1.22) than those treated by female physicians, regardless of patient sex, in adjusted analysis. Differences in CATH (p = 0.66) and REVASC (p = 0.32) use were not greater when a patient and physician were of different sexes. CONCLUSION: Though male patients and patients treated by male physicians were more likely to undergo cardiac catheterization and coronary revascularization post-MI, differences in procedure use were not greater when a patient and physician were of different sexes, suggesting that factors other than sex bias account for sex differences in cardiac procedure use. PURPOSE: Patient satisfaction instruments are frequently used to measure the quality of care provided by physicians and practices. Because these instruments are used for diverse purposes, however, they often become long and difficult for patients to complete, especially those from vulnerable populations. We attempted to reduce the 63-item Veterans Administration (VA) Ambulatory Customer Care Satisfaction Survey into a concise instrument focused on patients' concerns. METHODS: Patients were recruited sequentially at two VA Medical Center clinics and two medical clinics at a nearby University. Patients were first asked an open-ended question,``What is important to you regarding your outpatient clinic visits?'' They were instructed to provide comments based only on their ambulatory care, not inpatient or specialty care. Comments with similar themes were grouped into categories. For the second part of the task, they were shown a list of 15 randomly chosen items from the VA instrument and asked to rate each on a 5-point scale from``not at all important'' to``extremely important.'' A range of content and complexity was represented within each set of 15 items. RESULTS: A total of 496 patients participated. Most were middle-aged (mean age = 50.5, sd = 17.8), male (67.1%), and African ± American (59.9%); 38.7%had a high school education or less. A total of 879 comments were provided about their outpatient clinic visits. The majority of patients gave at least one (80.6%) or two comments (53.8%). The five topics volunteered most frequently were the wait time for appointments (31%), doctor ± patient interactions (14%), getting good service and care (11%), overall speediness (11%), and friendliness/courtesy by all staff (10%). However, when patients rated a list of existing items, the average rating for every item was above 4.0 (i.e., between``very important'' and``extremely important'').