The association between ventricular premature contractions (VPC) on routine ECG and sudden death (SD) from coronary heart disease (CHD) during an ll-year period was examined in a historic prospective study of 1,214 white male factory workers, ages 35-69, in Canton, North Carolina. Prevalence of VPC was 92 (6.7%) increasing from 2% to 15% with age. Sixty of the 118 deaths were ascribed to CHD, 38 (63.3%) with 24-hour SD, and 27 (45%) with 1-hour SD. The relative risk of 1-hour SD for those with VPC was not increased (0.9); the risk of 24-hour SD was increased only minimally (1.3). Within the age band 50-59, the relative risk of 24-hour sudden death was 2.4 but the presence of other electrocardiographic abnormality carried the same increased risk. For the Canton population, using VPC on routine ECG as predictor of sudden death yielded no advantage over other ECG abnormalities.

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The activities ofa multidiscipli nary team of mental health pro fessionals during their mit ial year of work to upgrade the mental health system in the English speaking Caribbean nation of Gre nada are described. Improvement ofservices at the island's only psy chiatric hospital received top pri ority. The team belpedGrenadian staff to sharpen basic techniques ofactive treatment, which included assessment of psychiatric symp toms, development of treatment plans, and intervention with pa tients. Maintenance ofmedical re cords was improved, pro ceduresfor medication and seclusion we,@ stan dardized, weekly ward rounds were routinized, and regular staff meetings were urged. Among the obstaclesfaced by the team in im Dr. Fisher is attending psychia trist in the division of inpatient services of the Connecticut Men tal Health

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