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Objective: The objective for this study was to identify predictors for participation in Pap smear screening in a socioeconomically disadvantaged older population., Design and Sample: A cross-sectional survey design was used to examine data from 238 southern women 50 years of age and older who were recruited from 24 randomly selected congregate meal sites of the Council on Aging., Measurements: The 45-item questionnaire covered demographics, Pap smear screening history, and colorectal cancer screening history., Results: Among this older, very low income population, women who had never had Pap smears (17.2%) were significantly more likely to have no phone or to be unable to use a phone (adjusted odds ratio (aOR) = 4.1; 95% confidence interval (CI) 1.6-10.6), to have annual incomes of less than $5,800 (aOR = 3.1; 95% CI 1.1-9.0), to be widowed (aOR = 2.8; 95% CI 1.1-7.3), to have no family history of cancer (aOR = 3.3, 95% CI 1.3-10.0), to report having never had a rectal examination (aOR = 5.4, 95% CI 1.8-16.0), and not to have participated in a free fecal occult blood testing program (aOR = 5.0, 95% CI 2.0-10.0)., Conclusions: These data, unique in including very low income (< $10,000) and older women (65 and over), found that income and access to a phone were strongly correlated with cervical cancer screening participation. Women who lacked external incentives for screening (being widowed and not having a family history of cancer) were less likely to obtain screening. This study's finding that "not having a phone" was a strong predictor for nonparticipation in cervical cancer screening has implications for national telephone-derived estimates of cervical cancer screening.

Two severely aphasic patients were compared in their abilities to comprehend and produce locative prepositional phrases and reversible S-V-O sentences using English and C-VIC, a computer-based iconographic communication system. One patient demonstrated a significant dissociation between his performance in interpreting symbol order in C-VIC prepositional phrases vs. S-V-O sentences. Patients were able to comprehend order in C-VIC S-V-O sentences significantly better than they were able to assign symbol order when they produced these sentences. These data suggest that the procedures for assigning thematic roles to nouns in sentences are at least partially distinct for comprehension and production and that the ordering of nouns around prepositions involves conceptual processes distinct from those involved in ordering nouns around verbs.

Few teaching programs are geared to meet the special learning needs of the elderly. This pilot study used a quasi-experimental pretest-posttest design to measure the effect of the Adaptation for Aging Changes (AAC) Method on fecal occult blood screening (FOBS) at meal sites for the elderly in the South. The AAC Method uses techniques that adjust the presentation to accommodate for normal aging changes and includes a demonstration of the procedure for collection of the stool blood test, memory reminders of the date to return the stool blood test, and written materials adapted to the 5th grade reading level. In addition, actual practice of the FOBS with the use of peanut butter was added to the AAC Method, making it the AAC with Practice Method (AACP) in two sites. The American Cancer Society's colorectal cancer educational slide-tape show served as the basis for all of the methods. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data from 135 Council on Aging meal sites' participants. The average age of the participants was 72 years; the average educational level was 8th grade; over half the sample was African-American; and half of the participants had incomes below the poverty level. Results support a significant increase in participation in FOBS in participants taught by the AACP Method [chi 2 (1, n = 56) = 5.34, p = 0.02; odds ratio = 6.2]. This research provides support for teaching that makes adaptations for aging changes, especially adaptations that include actual practice of the procedure.

Objective: To compare digital vascular responses to local finger cooling in 4 groups of subjects: patients with definite scleroderma (SD, systemic sclerosis) meeting ARA criteria (n = 16), patients with suspected early SD (n = 12), patients with primary Raynaud's phenomenon (RP) (n = 23) and a control group of 29 healthy subjects., Methods: Their digital systolic pressures were measured at 30, 20, 15 and 10 degrees C finger cuff temperature, in a room kept at 18 degrees C., Results: The results of the digital pressure measurements showed a clearcut difference between the SD, primary RP and control groups, but there was no difference between patients with definite SD and those with suspected early SD., Conclusion: Under our experimental conditions, digital pressure response to local cooling separates groups of patients with primary RP and those with secondary RP related to SD from each other and from controls. The similarity between digital pressure responses of patients with suspected early SD and those with definite SD, suggests an early organic involvement of the digital vasculature in SD.

The genetic structure of humpback whale populations and subpopulation divisions is described by restriction fragment length analysis of the mitochondrial (mt) DNA from samples of 230 whales collected by biopsy darting in 11 seasonal habitats representing six subpopulations, or 'stocks', world-wide. The hierarchical structure of mtDNA haplotype diversity among population subdivisions is described using the analysis of molecular variance (AMOVA) procedure, the analysis of gene identity, and the genealogical relationship of haplotypes as constructed by parsimony analysis and distance clustering. These analyses revealed: (i) significant partitioning of world-wide genetic variation among oceanic populations, among subpopulations or 'stocks' within oceanic populations and among seasonal habitats within stocks; (ii) fixed categorical segregation of haplotypes on the south-eastern Alaska and central California feeding grounds of the North Pacific; (iii) support for the division of the North Pacific population into a central stock which feeds in Alaska and winters in Hawaii, and an eastern or 'American' stock which feeds along the coast of California and winters near Mexico; (iv) evidence of genetic heterogeneity within the Gulf of Maine feeding grounds and among the sampled feeding and breeding grounds of the western North Atlantic; and (v) support for the historical division between the Group IV (Western Australia) and Group V (eastern Australia, New Zealand and Tonga) stocks in the Southern Oceans. Overall, our results demonstrate a striking degree of genetic structure both within and between oceanic populations of humpback whales, despite the nearly unlimited migratory potential of this species. We suggest that the humpback whale is a suitable demographic and genetic model for the management of less tractable species of baleen whales and for the general study of gene flow among long-lived, mobile vertebrates in the marine ecosystem.

To ascertain the effects of a natural disaster on adolescents, 1482 South Carolina high school students who were exposed to Hurricane Hugo were surveyed 1 year after the disaster. Subjects completed a self-administered questionnaire measuring Hugo exposure, nonviolent and violent life events, social support, self-efficacy, and psychological distress. Results showed that the students reported minimal exposure to the hurricane and psychological distress variables approximated national norms. As exposure increased, adolescents reported increased symptoms of psychological distress; i.e., anger, depression, anxiety, and global mental distress. Females and white students experienced higher levels of distress. In most cases, other stressful life events were at least as strong a predictor of psychological distress as was exposure to the hurricane. Self-efficacy and social support were protective.

Mass mortalities, due to infectious disease or toxic algal blooms, are known to have severe demographic impacts on marine mammal populations. The genetic impacts of these events, however, have received little attention. To investigate the genetic consequences of an unusual group mortality among humpback whales, we compared the mitochondrial DNA haplotypes of 10 whales poisoned by mackerel contaminated with a dinoflagellate neurotoxin to those of 32 live whales from the same regional population. Two haplotypes that were rare in the reference sample of live whales accounted for eight of the 10 poisoned whales. A randomized test of independence, based on 500 permutations of the data matrix, showed significant differences in the frequencies of haplotypes in the two samples (P < .002). This is the first demonstration that group mortality events in marine mammals can have unpredictable genetic consequences and points to a need to evaluate ecological disasters within the context of the genetic mosaic of natural populations.

A school-based study conducted in 1990, 1 year after Hurricane Hugo, investigated the frequency and correlates of post-traumatic stress disorder (PTSD) in 1,264 adolescents aged 11-17 years residing in selected South Carolina communities. Data were collected via a 174-item self-administered questionnaire that included a PTSD symptom scale. A computer algorithm that applied decision rules of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised to the symptoms reported was used to assign a diagnosis of PTSD and to designate the number of individuals who met the reexperiencing (20%), avoidance (9%), and arousal (18%) criteria. Rates of PTSD were lowest in black males (1.5%) and higher, but similar, in the remaining groups (3.8-6.2%). Results from a multivariable logistic model indicated that exposure to the hurricane (odds ratio (OR) = 1.26, 95% confidence interval 1.13-1.41), experiencing other violent traumatic events (OR = 2.46, 95% confidence interval 1.75-3.44), being white (OR = 2.03, 95% confidence interval 1.12-3.69) and being female (OR = 2.17, 95% confidence interval 1.15-4.10) were significant correlates of PTSD.

Hunting during the last 200 years reduced many populations of mysticete whales to near extinction. To evaluate potential genetic bottlenecks in these exploited populations, we examined mitochondrial DNA control region sequences from 90 individual humpback whales (Megaptera novaeangliae) representing six subpopulations in three ocean basins. Comparisons of relative nucleotide and nucleotype diversity reveal an abundance of genetic variation in all but one of the oceanic subpopulations. Phylogenetic reconstruction of nucleotypes and analysis of maternal gene flow show that current genetic variation is not due to postexploitation migration between oceans but is a relic of past population variability. Calibration of the rate of control region evolution across three families of whales suggests that existing humpback whale lineages are of ancient origin. Preservation of preexploitation variation in humpback whales may be attributed to their long life-span and overlapping generations and to an effective, though perhaps not timely, international prohibition against hunting.

This article reports on the elderly educator method, a practical and economical intervention that was used for increasing the rate of return of fecal occult blood sampling in colorectal screening among 171 socioeconomically disadvantaged older persons. Two methods that used elderly educators had an overall response rate of more than 60%. Logistic regression shows a statistically significant difference between two methods that used elderly educators and two methods that did not.

Humpback whales exhibit a remarkable social organization that is characterized by seasonal long-distance migration (> 10,000 km/year) between summer feeding grounds in high latitudes and winter calving and breeding grounds in tropical or near-tropical waters. All populations are currently considered endangered as a result of intensive commercial exploitation during the last 200 years. Using three hypervariable minisatellite DNA probes (33.15, 3'HVR, and M13) originally developed for studies of human genetic variation, we examined genetic variation within and among three regional subpopulations of humpback whales from the North Pacific and one from the North Atlantic oceans. Analysis of DNA extracted from skin tissues collected by biopsy darting from free-ranging whales revealed considerable variation in each subpopulation. The extent of this variation argues against a recent history of inbreeding among humpback whales as a result of nineteenth- and twentieth-century hunting. A canonical variate analysis suggested a relationship between scaled genetic distance, based on similarities of DNA fingerprints, and geographic distance (i.e., longitude of regional subpopulation). Significant categorical differences were found between the two oceanic populations using a multivariate analysis of variance (MANOVA) with a modification of the Mantel nonparametric permutation test. The relationship between DNA fingerprint similarities and geographic distance suggests that nuclear gene flow between regional subpopulations within the North Pacific is restricted by relatively low rates of migratory interchange between breeding grounds or assortative mating on common wintering grounds.

Six severely aphasic patients were trained on C-VIC, a computerized alternative communication system. Patients with both global and Broca's aphasia were able to produce and comprehend locative prepositions using C-VIC. The Broca's aphasic patients were able to produce and interpret symbol order correctly in C-VIC locative prepositional phrases, despite their difficulties in performing the same tasks using English. One patient's verbal production of locative prepositional phrases improved markedly after C-VIC training. These results suggest that the "mapping" impairment suffered by some Broca's aphasics may be ameliorated by use of alternative communication system, such as C-VIC.

We estimated the prevalence of Raynaud's phenomenon (RP) in the general population of 2 geographic areas, Charleston County, South Carolina, USA, and Tarentaise, Savoie, France, using the same methodology in both countries. The first phase of the study, consisting of the telephone survey of a randomly drawn sample of households, yielded 2086 completed interviews in Charleston and 2000 in Tarentaise. Cold sensitivity or unusual digital color changes were reported by 17.9% of the subjects in Charleston and by 31.3% in Tarentaise. In the second phase of the study the diagnosis of RP was made by a medical team. Based on these results, the estimated prevalence of RP is 5.0% (0.8% SE) in Charleston (women 5.7%, men 4.3%) and 16.8% (2.0% SE) in Tarentaise (women 20.1%, men 13.5%).

Cancer screening is a national health priority, especially for colorectal cancer, the second leading cause of death due to cancer in the United States. The researchers measured colorectal cancer knowledge among 211 older Americans. A quasiexperimental pretest-posttest two-by-two factorial design was used to test the effect of knowledge on participation in fecal occult blood screening. The American Cancer Society's colorectal cancer educational slide-tape presentation served as the basis for all of the educational programs. Hemoccult II kits were distributed at no cost to the participants. Descriptive statistics, chi 2, and logistic regressions were used to analyze data. One-half of the participants had incomes below the poverty level. Almost one-half the subjects in the study sample stated that they had not received any information about colorectal cancer within the past year. Caucasians had more knowledge of colorectal cancer than African Americans [F(1, 78) = 7.92, p < 0.01] and persons with higher income had more knowledge than persons with less income [F(2, 76) = 3.01, p = 0.05]. Subjects showed significant increases in colorectal cancer knowledge 6 days after the colorectal cancer education program [t(79) = 2.59, p = 0.01] and this increased knowledge was a predictor of participation in free fecal occult blood screening [chi 2(1, n = 164) = 5.34, p = 0.02].

This descriptive study, one component of the Carolina Adolescent Health Project (CAHP), measured self-efficacy in a voluntary sample of 432 normal freshmen and sophomore urban high school students. Using Coppel's Self-Efficacy Scale (SES), which is based on Bandura's conceptualization of self-efficacy, the research also examined the effect of gender, race, socioeconomic status, and self-reported religiosity on self-efficacy. The teenagers in this sample had a moderately high degree of self-efficacy with a mean SES score of 45.37 (SES range = 13-65). A series of t tests and one-way and two-way analyses of variance indicated no significant difference in SES scores by race, gender, socioeconomic status, or religiosity. Findings did not support the investigators' original expectation that these demographic and psychosocial variables would affect self-efficacy. The study provides normative data for future comparative studies using the SES.

The correct identification of syndromes and other congenital malformations at an early age is critical for the child, family and care providers. Most specialists who conduct large screenings of young children are not adequately trained to recognize signs and symptoms that should lead to appropriate referral to the clinical geneticist and/or diagnostic team. A systematic approach for recognizing important signs is presented here; a Craniofacial Screening Profile. Following a brief training program, the Profile was validated by 39 speech-language pathologists in screening 3,539 kindergarten and first grade children. The results were excellent (specificity was 99.6%), demonstrating that with limited training, specialists can effectively screen for important signs and symptoms of a major group of syndromes and other congenital malformations.

Our study has identified the demographic, social and clinical correlates of primary Raynaud phenomenon (RP) from a case-control study involving 235 subjects who were identified from a population-based prevalence survey of RP. All potential cases and a sampling of probable non-cases, identified by a screening questionnaire, were invited to a medical clinic for diagnostic testing and assignment of case or control status. Odds ratios (OR) for risk indicators for primary RP were estimated using multiple logistic regression to obtain 95% confidence intervals. The regression yielded statistically significant (p less than 0.05) positive associations for sex (OR = 3.0 for females versus males), self-reported alcohol use (OR = 1.1) and diastolic blood pressure (OR = 1.2) in those on antihypertensive medication. A significant (p = less than 0.01, OR = 0.4) negative association was found for Quetelet index (a measure of obesity). Near-significant or suggestive but non-significant negative associations were found between RP and marital status (p = 0.05, OR = 2.5), increased years of education and, for those on antihypertensive medication, higher systolic blood pressure (both p = 0.07).

Evaluating the effectiveness of nursing interventions in decreasing pain is a top priority for clinical research. Unfortunately, most of the research on cancer pain relief has been limited to treatment studies involving the administration of analgesics. Research is needed to determine which nonanalgesic methods of pain control are effective and under what conditions. Consequently, an experimental study was designed to test the effectiveness of massage as an intervention for cancer pain. Twenty-eight patients were randomly assigned to a massage or control group. The patients in the massage group were given a 10 minute massage to the back; the patients in the control group were visited for 10 minutes. For males, there was a significant decrease in pain level immediately after the massage. For females, there was not a significant decrease in pain level immediately after the massage. There were no significant differences between pain 1 hour and 2 hours after the massage in comparison with the initial pain for males or females. Massage was shown to be an effective short-term nursing intervention for pain in males in this sample.

This study of 62 individuals with Raynaud phenomenon (RP) drawn from the general population of South Carolina shows a profile of associated diseases that is different from the one reported from hospital based studies. We found that connective tissue diseases affect a much smaller fraction of patients with RP than previously reported. Compared to RP negative controls, our RP positive group was found to suffer more frequently from a variety of diseases, both RP related and not RP related.

Humpback whales (Megaptera novaeangliae) migrate nearly 10,000 km each year between summer feeding grounds in temperate or near-polar waters and winter breeding grounds in shallow tropical waters. Observations of marked individuals suggest that major oceanic populations of humpback whales are divided into a number of distinct seasonal subpopulations which are not separated by obvious geographic barriers. To test whether these observed patterns of distribution and migration are reflected in the genetic structure of populations, we looked for variation in the mitochondrial DNA of 84 individual humpback whales on different feeding and wintering grounds of the North Pacific and western North Atlantic oceans. On the basis of restriction-fragment analysis, we now report a marked segregation of mitochondrial DNA haplotypes among subpopulations as well as between the two oceans. We interpret this segregation to be the consequence of maternally directed fidelity to migratory destinations.

A prevalence estimate for Raynaud phenomenon among adult residents of South Carolina was based on data obtained from respondents in a statewide health survey, followed by face-to-face interviews and clinical screening for Raynaud phenomenon, using a screening procedure developed by the authors. The survey obtained 5246 personal interviews from a probability sample of over 3000 households, and 494 survey subjects participated in the clinical screening. The prevalence estimates and their standard errors were computed using survey case weights, design-based estimation, and logistic modelling techniques. The prevalence of Raynaud phenomenon among adult residents of South Carolina was determined to be 3.5%, with a standard error of 0.6%. Prevalence was higher for females (4.3%, SE = 0.7%) than for males (2.7%, SE = 0.6%). These figures are much lower than most estimates in the existing literature on Raynaud phenomenon.

In normal subjects, somatosensory evoked potentials (SEPs) were produced by increases or decreases of the load on the biceps muscle during voluntary contraction. The stimuli lasted only 20 msec and caused less than 2 degrees of elbow flexion or extension. When the stimulus was applied during voluntary movement of the elbow, the SEP was attenuated, and the subject was less able to discriminate between loading and unloading pulses. In each of eight subjects, there was a positive correlation between the percentage of correct responses and the size of the SEP. The measurement of both SEPs and perceptual accuracy under various test conditions provides a refined technique for studying the relations between electrical events and sensory processes.

Stretch and unloading reflexes were demonstrated in the first dorsal interosseous muscle by averaging the electromyographic responses to brief mechanical stimuli. Subjects were not able to abolish these reflexes by altering their preparatory set. When subjects were prepared to contract or relax the muscle in response to a stretching force, the size of the stretch reflex was not affected significantly. When they were prepared to contract or relax in response to unloading, the "silent period" was diminished. In general, these reflexes were not modulated appropriately to improve the performance of an intended voluntary movement. Our results do not support the notion that spinal reflexes of the intrinsic hand muscles are "dominated" by corticospinal inputs.

Psychophysiological studies in schizophrenics have generally resulted in contradictory and inconclusive reports. The purpose of the present study was to determine whether a better psychophysiological separation of schizophrenic and control subjects could be accomplished by selecting them on the basis of a biological marker: the high plexus visualization score (PVS). Finger blood flow, skin temperature and electrodermal recovery rates were studied in 64 male schizophrenics (33 high PVS and 31 low PVS) and 24 male controls (10 high PVS and 14 low PVS) matched for age. All control subjects and 30 of the schizophrenics (16 high PVS and 14 low PVS) had been drug-free for at least 1 month. They were studied in a sound attenuated, temperature controlled room under 12 experimental conditions. The results demonstrate that, as predicted, schizophrenics with high PVS have the lowest finger blood flow rates, the lowest skin temperatures and the slowest GSR recovery rates of all groups studied. The largest difference in all three variables was found between high PVS schizophrenics and high PVS controls. The blood flow rates and the skin temperature were higher and the electrodermal responses were fewer in patients taking medications than in those receiving placebos. A suggestion of a bimodal distribution into "responders" and "non-responders" was apparent only in patients receiving medications.

Tactile stimuli were applied to the right index finger at selected times following rapid movements of the thumb. The probability of detecting a stimulus was found to be impaired for at least 250 ms after completion of a voluntary movement. This finding complements previous work showing that somatosensory evoked potentials are reduced for a comparable period following movement.

The frontal agranular cortex consists of at least three major subdivisions: the precentral motor cortex, the supplementary motor cortex, and the premotor cortex. Of these, the premotor cortex is by far the least intensively studied by neurophysiological methods in spite of recent evidence that it is important in higher order aspects of the cerebral control of movement ( Moll and Kuypers , 1977; Roland et al., 1980b ; Halsband and Passingham , 1982). We have accordingly studied neuronal activity in the premotor cortex of Rhesus macaques operantly conditioned to perform a visually guided motor task. We have concluded that many premotor cortex neurons appear to reflect motor set. Further, these and other premotor cortex neurons show activity patterns during and before the execution of an abstractly guided movement that are strikingly similar to what has been observed in association with movements made directly to visuospatial targets. Finally, a functional relationship of some premotor cortex unit activity to the execution of voluntary movement is supported by its close temporal correlation with the onset of movement, a significant correlation with the acceleration of the limb in some cases, and a uniform specificity for movement execution rather than the visuospatial cues that guide the movement.

The descriptive epidemiology of the spectrum of orofacial cleft disorders has many methodologic problems, including (1) casefinding using data sources such as birth certificates, fetal death certificates, and hospital records that often produce ascertainment bias, selection bias, or both and (2) the multiple comparisons problem (i.e., the chance occurrence of statistically significant findings). The resultant incidence and prevalence rates from studies with inadequate designs or inadequate data are limited and may be misleading. A variety of reasons is advanced to explain the wide discrepancies in reported statistics on orofacial clefting from different geographic areas, ethnic groups, and time periods. Specific recommendations are offered for producing better epidemiologic data. An example of how higher quality descriptive statistics can be used for future hypothesis testing is also provided.

Head oscillations in response to whole body oscillation of Parkinsonian patients before and after administration of levodopa were compared with those of normal subjects. Parkinsonian patients developed large increases in the amplitude of their head movements while fixating a stationary target after administration of levodopa. This increase was proportional to disease severity and was maximal in stage IV patients with levodopa induced dyskinesias. These findings indicate a fundamental yet reversible change in the strategy of eye-head coordination in Parkinsonian patients after administration of levodopa which may be due to release of normally inhibited visuo-vestibular reflexes.

We studied a cohort of 2275 blacks and whites of both sexes in Charleston County, South Carolina, during the period of 1960-1961 to 1974-1975. There were 93 prevalent cases of coronary heart disease (CHD) at intake, and 317 new cases occurred by 1975 in persons originally free of CHD. White males had the highest incidence rates for all types of CHD and acute myocardial infarction (AMI). Black males and black females had the next highest rates. The incidence of angina pectoris in black females was double the rate in white females and five times the rate in white males. The rate of sudden death in black males was two and one-half times the rate in black females, three times the rate in white males, and four times the rate in white females. One hundred and one black males who had been selected on the basis of high socioeconomic status (SES) had AMI and CHD rates half that of other black males. None of the high SES black males experienced angina pectoris, AMI death, or sudden death during the observation period.

In normal subjects, cerebral potentials were evoked by brief, passive extension of the wrist joint at various interstimulus intervals (ISIs). The resulting somatosensory evoked potentials (SEPs) were found to decrease during repetitive stimulation. The greatest decrement occurred between the first and second responses of each series. After cessation of stimuli, the SEP amplitude returned to control values over a prolonged, exponential time course. The authors postulate that the observed response decrement may be a form of habituation, which provides a model for studying the neuronal substrates of behavior.

In 1984-1985, the authors interviewed 1,017 participants in the Charleston Heart Study in Charleston County, South Carolina to investigate the measurement properties of the Framingham Type A Scale in elderly blacks and whites and those of the John Henryism Scale for Active Coping, which was originally designed for use in black populations. They conclude that the Framingham Type A and John Henryism scales do in fact measure two quite different behavior patterns, and do have different correlates in elderly blacks and whites. The results are of particular interest since the Charleston Heart Study sample includes an oversampling of high socioeconomic status black males (n = 69). In this respect, it is unique among long-term cardiovascular studies and provides the opportunity to estimate separate race and socioeconomic status effects, as well as to examine their interaction.

Sensory transmission is known to be impaired during movement of the stimulated body part. The goal of this study was to determine whether sensory gating persists for a measurable time after completion of a voluntary movement. Tactile stimuli were applied to the right index fingertip at intervals ranging from 63 to 1,000 msec after the completion of rapid thumb movement. Somatosensory evoked potentials (SEPs), recorded over the left cerebral hemisphere, were found to be reduced in size for at least 500 msec after the cessation of movement. The prolonged attenuation of SEPs after movement appears to depend on a central process that persists for a measurable time after the movement has ended.

Community surveillance revealed 1085 prevalent cases of acute myocardial infarction (AMI) during 1978 in urban metropolitan Columbia and rural Pee Dee areas of South Carolina. Six hundred fifty-eight hospitalized cases met our criteria and were classified as definite or probable. Death certificates identified 427 who died before admission to the hospital and who were classified as unvalidated. However, there is need to verify death certificate diagnosis in out-of-hospital deaths which account for approximately two thirds of total cases in blacks and about one third of white cases. Other findings were: White males had higher AMI rates in the rural Pee Dee area than in urban Columbia, while black males and black females had higher rates in Columbia than in the Pee Dee area and white females had similar rates in both areas. Rates for out-of-hospital AMI mortality were higher in blacks than in whites. Out-of-hospital AMI mortality rates in Columbia and the Pee Dee area were four times higher than in Minneapolis-St. Paul in 1978. For definite and all criteria AMI, white males had the highest rates, double the black male rate except for all criteria AMI in Columbia, where white male and black male rates were similar. Urban cases of both races experienced more anterior infarctions than rural cases.

A short questionnaire inquiring about cold sensitivity of the fingers was administered to 1752 randomly selected subjects in a probability sample drawn from the adult population of the state of South Carolina. The overall prevalence of reported cold sensitivity was approximately 10% and showed no sex or race difference. A female preponderance was revealed only after subjects exposed to vibrating tools were excluded, and then only in the white group. Estimates of the prevalence of Raynaud phenomenon were obtained using the following criteria: cold sensitive subjects reporting white and/or blue color changes: 4.6%; cold sensitivity leading to medical consultation: 3.0%; combination of the two criteria above: 1.9%.

The prevalence of scleroderma spectrum disorders (including systemic sclerosis [SSc] meeting the American Rheumatism Association criteria and the less typical disorders meeting only our study criteria) was determined in a random sample of 6,998 subjects from the general population of South Carolina. The results suggest that the prevalence of these disorders may range from 67 to 265 per 100,000, which is 4.9 to 19.2 times higher than previously reported for definite SSc. The ratio of nondefinite cases to definite cases of SSc (those meeting American Rheumatism Association criteria) was 2.5. Most of the nondefinite cases were unrecognized prior to our study, which suggests the need for improved early diagnosis of scleroderma spectrum disorders. Brief histories of the 7 patients with scleroderma spectrum disorders whose cases formed the basis for our calculation of prevalence rates are included in this report.

The rural Pee Dee area of South Carolina has had the highest mortality rate in the nation for coronary heart disease. Community surveillance shows a 22.7% (p = 0.0008) decline in fatal and nonfatal acute myocardial infarction (AMI) rates during the period 1978 to 1985 in the Pee Dee area. Rates for white men decreased 32% (p = 0.001), whereas in other race-sex groups changes were not significant, although there was a downward trend (p = 0.18) among black men. Among white men decreases in the AMI rates occurred in each of the decades of age 35 to 64 years. In all race-sex groups there was a sharp increase in rates between 1978 and 1985 for those 65 to 74 years of age, suggesting that the incidence of AMI was delayed to a later age. Out-of-hospital AMI death rates declined markedly in all race-sex groups: 63% for white men, 62% for white women, 49% for black men, and 39% for black women. Overall case fatality rates declined from 14% (27 of 193) to 10% (23 of 232), but the decrease was not statistically significant.

The authors describe their recently developed Computer-aided VIsual Communication (C-VIC) system, and report results of single-subject experimental designs probing its use with five chronic, severely impaired aphasic individuals. Studies replicate earlier results obtained with a non-computerized system, demonstrate patient competence with the computer implementation, extend the system's utility, and identify promising areas of application. Results of the single-subject experimental designs clarify patients' learning, generalization, and retention patterns, and highlight areas of performance difficulties. Future directions for the project are indicated.

A simple questionnaire, combined with color charts consisting of a 12-point color scale and a series of photographs illustrating blanching and cyanosis, has been developed to assist in the diagnosis of Raynaud's phenomenon (RP). The value of the color charts alone was first tested on a group of 48 patients with RP in whom the RP attacks were witnessed by the investigators (gold standard) and on a group of 246 RP negative subjects; the results showed a sensitivity of 90% and a specificity of 100%. A short RP diagnostic test was then devised by combining the questionnaire and color chart responses, which increased the sensitivity to 100% in our gold standard group of RP positive subjects. Further evaluation of this RP diagnostic test on a sample of 325 subjects whose RP status was unknown demonstrated that the majority could be classified as clearly RP positive or negative with only 4 subjects in the intermediate category.