Among the out of custody group, Hispanics, persons of younger age and those in outpatient substance abuse treatment programs were significantly less likely to received HIV prevention services. Among the continuously incarcerated group, women, persons of younger age and those in outpatient substance abuse treatment programs were least likely to receive these services. Both the in custody and out of custody groups exhibited HIV risk behavior reductions after twelve months of follow-up. However, controlling for baseline HIV risk behavior and other possible confounders, receiving HIV prevention services was associated with less risk behavior only among the out of custody group (=À.14, P=.04). No association was observed among the group that was continuously incarcerated throughout the follow-up period. CONCLUSION: This analysis suggests that HIV prevention services are beneficial in reducing risk behavior among inmates whose discharge is expected in the near future. The benefit of administering these services in individuals with longer sentences earlier in the incarceration period is unclear. Lifestyle changes, such as smoking cessation, can play a pivotal role in outcomes following the diagnosis and treatment of coronary heart disease (CHD). However, many patients with CHD are not motivated to make lifestyle changes even after undergoing coronary revascularization. Prior studies have shown that time orientation is a major motivational determinate of an individual' s behavior and more specifically as it relates to healthy lifestyle choices. Therefore, we sought to examine the association of future orientation with readiness to make healthy lifestyle changes in a diverse group of patients at high risk of CHD. METHODS: Forty patients scheduled for elective coronary angiography were identified in the fall of 2000. High risk patients were those with one or more of the following: diabetes, hypertension, or hyperlipidemia. Following informed consent, a baseline 20-minute structured bedside interview was conducted, which collected information on the following: demographics (e.g. age, race, and sex), high-risk behaviors (e.g. smoking) using the interview format of the Computerized Lifestyle Assessment (CLA), and future orientation using Carstensen and Lang' s Future Orientation Scale. This latter scale measures the extent that one perceives there is sufficient time to achieve his/her goals. A follow-up interview was conducted 3 months from baseline to assess readiness to change as measured by the CLA. RESULTS: Follow-up data were completed on 33 subjects (83%). Their mean age was 58 years (S.D.=10.4), 64% were women, 42% were Hispanic, 27% were White, 21% were Black, and 10% were Others. Most patients (79%) did not exhibit any movement in readiness to change their lifestyle or habits as measured by the CLA subscale. Overall, 15% of patients had movement toward adopting a healthier lifestyle following angiography, such as improving their eating habits and exercising; 6% regressed. Patients who were future oriented (n= 16) had the most progress in movement toward making healthy changes in exercise (25%), diet (10%), and smoking (10%), compared to 17%, 23%, and 6% respectively of patients who were present oriented. However, 13% of future oriented subjects had an overall decrease in their readiness to change score following angiography, compared to none (0%) of the 17 patients who were present oriented. CONCLUSION: These data suggest that patients at high-risk of CHD, as well as those who are future oriented, may be slow to make lifestyle changes following angiography. These findings also indicate that there is a need for more research to ascertain patients' perception of their personal coronary risks. Primary care and other health providers can use such novel information to implement individually relevant educational programs to address motivational factors related to health behavior. RESULTS: There were 1006 patients surveyed with a refusal rate of 20.3%. The study patients did not differ from the total population who accessed care during this time period in regards to age, insurance status, ethnicity, or gender. After controlling for several factors, including age, gender, and the presence of chronic medical conditions, Hispanic patients were more likely than white patients to report having a regular source of health care (p = 0.008) or a regular physician (p = 0.018). However, Spanish speaking patients were less likely to note a regular physician (p < 0.0001) than English speaking patients. Black patients were more likely than white patients to note a regular source of care (p = 0.04) but not a regular physician (p = 0.8108). Hispanic patients were 1.7 times more likely to have visited the ED or UCC in the past year than our white patients (p = 0.006). However, Spanish speaking patients had less use of these services (p = 0.01) than English speaking patients. CONCLUSION: Sociocultural issues such as race and English fluency likely contribute to utilization of resources such as EDs and UCCs. For example, in our population minorities tended to utilize EDs and UCCs more often than white patients, but were also more likely to report that they had a regular source of care. Given the racial disparities in health outcomes there is an imperative to address this problem with additional studies. Simply attempting to redirect patients who inappropriately utilize EDs and UCCs to their regular source of care is unlikely to succeed unless language and cultural issues are addressed. where an aggressive approach to care following acute myocardial infarction (AMI) is more commonly adopted in comparison to a conservative approach, the aggressive approach may be associated with small incremental (marginal) mortality benefits. We conducted this study to evaluate the effectiveness of aggressive care following AMI in Canada. We hypothesized that the marginal benefits should be larger in Canada, as the country is operating on a lower margin because the approach to care is more conservative overall. METHODS: We conducted a retrospective cohort study using administrative data of acute care hospital admissions and in-and out-patient services for all patients who sustained a first AMI in Quebec in 1988 (n=8674). We used differential distances to hospitals offering aggressive care as instrumental variables to control for unobserved case-mix variation when measuring mortality up to 4 years after first AMI. RESULTS: Of the 4422 subjects who were > 64 years old, 11% received cardiac catheterization within 90 days after admission. In a previous study that applied similar methodology to the 1987 United States (US) Medicare population of first AMI patients, 30% of subjects received catheterization within 90 days. As in the US study, we found that subjects living relatively close to hospitals offering aggressive care were more likely to receive aggressive care (26% of``close'' versus 19% of``far'' subjects received cardiac catheterization within 90 days; 95% CI: 5% to 9%). Unlike the US study, we found no differences in mortality across the``close'' versus``far'' differential distance groups (unadjusted differences at 1 year: 1%; 95% CI: À1% to 3%). This absence of association was found in elderly ( > 64 years) and younger age groups. Adjusted results also showed no differences between subjects receiving aggressive versus conservative care (at 1, 2 and 4 years: 4%, 2%, À4%; 95% CI: À11% to 20%, À15% to 18%, À26% to 8%, respectively). CONCLUSION: Contrary to our hypothesis but consistent with results from numerous randomized trials and observational studies, the aggressive approach to post-AMI care does not appear to be associated with marginal mortality benefits even in Canada, where the approach to post-AMI care is conservative overall. Although clinicians may prefer results that are reported as``normal'' or``abnormal,'' this usually requires the specification of an artificial diagnostic criterion. Diagnostic information is typically lost in this simplification process. One application of the mutual information function is the calculation of the amount of information lost as test results are dichotomized. Consider, for example, a population of individuals in which the probability of disease is 0.5. Assume that the``healthy'' and``diseased'' individuals in this population are normally and identically distributed with respect to some diagnostic marker, except that the means of the two populations are separated by one standard deviation. In this case, I(Dx;T) = 0.16 bits. If, however, the results are dichotomized using the optimal cutoff (the midpoint between the means of the two populations) then I(Dx;T) is reduced to 0.11 bits. CONCLUSION: Information theory provides a framework for understanding diagnostic testing. This perspective suggests that mutual information, rather than the AUC, provides the appropriate summary index of diagnostic test performance. PURPOSE: Racial disparities in procedure use for acute myocardial infarction (AMI) have been well documented in selected populations in the 1980s and early 90' s, but little is known about recent trends in disparities in the general population. METHODS: We conducted a series of cross-sectional analyses of data from the Nationwide Inpatient Sample (which includes race and demographic, diagnostic and procedure data on all discharges from over 900 representative hospitals in 18 states) for 1995 through 1997 to compare rates of catheterization performed prior to discharge for acute myocardial infarction (ICD9 code 410) in whites vs. blacks. RESULTS: We identified 298,496 discharges among whites and 23,496 discharges among blacks with AMI as the first listed diagnosis during 1995 ± 97. Age-adjusted catheterization rates by race are presented in the figure. From 1995 to 1997, age-adjusted peri-AMI catheterization rates increased more sharply in blacks (39% to46%) than in whites (48% to 52%; p < 0.01). After adjustment for age, gender, comorbidity, region, and rural locale using Poisson regression, the incidence rate ratio (IRR) for peri-AMI catheterization in blacks compared to whites in 1995 was 0.84 (95% confidence interval (CI) 0.78 ± 0.90). During the next two years, the gap progressively narrowed, such that in 1997 the adjusted IRR was 0.90 (95% CI 0.83 ± 0.96). Similar results were obtained when we restricted the analysis to discharges from hospitals that performed catheterizations. CONCLUSION: These recent nationwide data suggest that, while blacks remain less likely to undergo catheterization during a hospitalization for AMI than whites, this racial gap appears to be narrowing.