Blood pressure levels were examined with regard to church attendance patterns in a group of white male heads of households who appeared in the 1967-1969 follow-up examination of the Evans County Cardiovascular Epidemiologic Study. A consistent pattern of lower systolic and diastolic blood pressures among frequent church attenders was found compared to that of infrequent attenders which was not due to the effects of age, obesity, cigarette smoking, or socioeconomic status.

The in vitro influence of glucose, fructose, and insulin on human leukocytes of healthy and diabetic subjects was measured as a part of a study of the metabolic behavior of these cells, and an attempt was made to correlate metabolic alterations in leukocytes with resistance and susceptibility to infectious diseases. Previous workers have shown that leukocytes from alloxan diabetic rabbits are able to phagocytize but not destroy bacteria (1). Dubos has shown that lactate in the presence of low oxygen tension is bactericidal for M. tuberculosis (2). Human leukocytes produce lactic acid in the presence of oxygen, and the quantity is not changed markedly by decreased oxygen tension (3, 4). It has also been shown that these cells produced more lactate from glucose than from fructose, and that when the two sugars were added simultaneously the lactate production was additive. The effect of these hexoses and insulin was studied on leukocytes from normal and diabetic subjects. The responses after cell injury were also determined. METHODSHealthy subjects and subjects with moderately severe untreated diabetes mellitus were used as donors. The obese mild diabetics were excluded from this series. The blood was collected before breakfast. The white

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SUMMARY In order to assess the impact of variations in stroke care on outcomes, and to make geographic comparisons, the three Community Hospital-Based Stroke Programs in North Carolina, Oregon, and New York, aggregated their data on 4,132 hospitalized stroke patients. Complete demographic data or "Major Profile" were obtained on 2,390 (57.8%) of the 4,132 stroke patients. This includes those patients on whom informed patient and physician consents were obtained during the hospitalization. Of the major profile patients, 1,490 (62.3%) were followed for periods up to one year, 502 (21.0%) were lost to followup and 398 (16.6%) died within the one year followup period. Incomplete demographic data or "Minor Profile" were observed on 1,742 (42.1%) of the 4,132 patients. Minor profile includes those who died before comprehensive interviews were completed or those for whom informed consent for an interview could not be obtained. Of the minor profile group, 813 (46.7%) died in hospital, and 929 (53.3%) were alive when discharged from the hospital. This paper, which describes the programs, data collection procedures, and study cases, also highlights specific issues on stroke diagnosis, risk factors associated with stroke, and the influence of interventions on stroke outcomes. We conclude that: 1) the merging of data on hospitalized stroke cases from rural and urban hospitals in geographically distinct regions can be used in the study of stroke diagnosis, the use of diagnostic tests, and the effect of interventions on stroke outcomes; and 2) these data are consistent with the hypothesis that part of the national decline in mortality from stroke is due to a decline in stroke severity. Stroke Vol 17, No 2, 1986 RECENT STUDIES have indicated substantial reduction in stroke mortality during the past three decades. However, stroke persists as the third major cause of death and disability among adults.

We evaluated survival following stroke for patients from a five-county area of rural North Carolina enrolled in either of two community hospital-based stroke survey programs. In this area, the first program enrolled 843 stroke patients between 1970 and 1973 and the second program enrolled 786 stroke patients between 1979 and 1980. One-year survival increased from 49% in the first program to 62% in the second for all stroke patients, from 54% to 68% for patients with cerebral infarction, and from 18% to 55% for patients with cerebral hemorrhage. While other reports have attributed declining stroke mortality to a decline in the incidence of stroke, our study suggests that increased survival after stroke may account for a large portion of the decrease in stroke mortality. (Stroke 1989;20:345-350) T here has been a well documented and dramatic decline in stroke mortality 1 -5 since 1914 as well as much speculation regarding its cause(s). Declining stroke mortality must result from lowered stroke incidence and/or improved survival following stroke. Whisnant 4 demonstrated a decrease in stroke incidence in Rochester, Minnesota, that he attributed to advances in antihypertensive therapy. In reviewing Whisnant's report, Hachinski 6 agreed that the decline in mortality could be explained by a decrease in incidence but questioned whether more effective and widespread treatment of hypertension was the singular cause of the decline.The extent to which incidence studies conducted in "special" communities such as Rochester, Minnesota, or Framingham, Massachusetts, are representative of the US population may be debated. For example, Whisnant 4 noted that "antihypertensive Received April 27, 1988; accepted September 7, 1988. treatment was used rather frequently in Rochester after 1955. . .", a situation that clearly did not reflect practices in average health care. Dyken 7 noted that the relatively small improvement in acute stroke survival in Rochester (from 80% in 1945-1949 to 82% in 1970-1974) may indicate a higher quality of medical care earlier. Because a high standard of health care has been the norm in these special communities, improvements in their case fatality rates may not be representative of the situation for the nation as a whole. Nationwide, survival after stroke has also apparently been improving in both acute and long-term studies.7 Despite problems of comparing studies performed in different geographic/medical settings, Dyken 7 has observed that in studies completed before 1965 acute survival (38-63%) was much lower than in studies completed after that date (70-81%); he also noted similar improvements in long-term survival. Increased survival may be more important to declining stroke mortality nationwide than is apparent in either Rochester or Framingham.Expected survival after stroke has profound implications, not only for the patient and his or her care, but also for planners of health care systems. Previous studies of survival following stroke 8 -12 have identified numerous factors related to surviv...