Roger C. Grimson

Plasma selenium and skin neoplasms: A case‐control study

Although experimental studies in animals show that selenium may prevent cancer, case-control studies of internal human cancers have been difficult to interpret because neoplastic tissue sequesters selenium. We therefore conducted a case-control study to examine the association between plasma selenium level and skin cancer, a neoplasm with minimal tumor mass at the time of diagnosis. The mean selenium level among patients with either basal cell epithelioma (N = 142), squamous cell carcinoma (N = 48), or both (N = 50), was 0.141 micrograms/g. This was significantly lower than the mean plasma selenium level of the 103 control subjects, which was 0.155 micrograms/g. The noncancer control groups were drawn from current clinic patients and past clinic patients. The logistic estimate of the odds ratio for the lowest versus the highest decile of selenium for all cases combined versus the group of current patient controls was 4.39; for all cases combined versus the past patient controls, the logistic estimate of the odds ratio was 5.81.

Prevalence of self-reported depressive symptoms in young adolescents.

To investigate the significance and measurement of depressive symptoms in young adolescents, 624 junior high school students were asked to complete the Center for Epidemiologic Studies Depression Scale (CES-D) during home interviews. In 384 usable symptom scales, item-scale correlations (most were above .50), inter-item correlations, coefficient alpha (.85), and patterns of reported symptoms were reasonable. Persistent symptoms were reported more often by Blacks, especially Black males. Prevalence of persistent symptoms in Whites was quite close to reported figures for adults, ranging from 1 per cent to 15 per cent in adolescent males and 2 per cent to 13 per cent in adolescent females. Adolescents reported persistent vegetative symptoms less often and psychosocial symptoms more often. Reports of symptoms without regard to duration were much more frequent in the adolescents, ranging from 18 per cent to 76 per cent in White males, 34 per cent to 76 per cent in White and Black females, and 41 per cent to 85 per cent in Black males. The results support the feasibility of using a self-report symptom scale to measure depressive symptoms in young adolescents. Transient symptoms reported by adolescents probably reflect their stage of development, but persistent symptoms are likely to have social psychiatric importance.

The Edgecombe County High Blood Pressure Control Program: I. Correlates of uncontrolled hypertension at baseline.

To guide the planning of a multifacetted hypertension control program in Edgecombe County, North Carolina, a baseline survey of a stratified (by township) random sample of 1,000 households was conducted. All adults (greater than or equal to 18 years) were interviewed and had their blood pressures (BP) measured. Five hundred thirty-nine individuals, 27 per cent of the survey population, had diastolic BP greater than or equal to 90 mm Hg or were receiving anti-hypertensive drug therapy. The 539 hypertensives were divided into seven subgroups reflecting successive stages in the control of hypertension based on the awareness, treatment, and control of their hypertension. Unaware hypertensives were further subdivided into three groups according to the recency of their last BP check, and those aware but untreated were subdivided by whether they had previously received treatment. The seven subgroups of hypertensives were compared, separately for women and men, with respect to sociodemographic characteristics, health behaviors, and health status. In general, the progression from undetected hypertension to treatment and control appeared to be associated with being older, female, and White. This progression was further associated with greater educational levels and higher family incomes among women and increasing self-reported morbidity among men. The implications for intervention of these and other described associations are discussed.

Searching for hierarchical clusters of disease: Spatial patterns of sudden infant death syndrome

Abstract This paper presents simple and inexpensive methods of recognizing patterns of epidemicity of varying intensity in geographical areas, and of testing for clusters. These methods are designed for available data which are reported on a county (or other geographical unit) basis. The methods are based on a simulated distribution of county “adjacencies”. An interesting pattern of the incidence of sudden infant death syndrome is recognized.

The clustering of disease

Abstract Formulas which are useful in studying disease epidemicity are presented, and the combinatorial and asymptotic rationales of the underlying model are explored. The Ederer-Meyer-Mantel cluster test can be used to see if clustering of a disease exists in time and space; if clustering exists, then our cluster model may be used to advantage on the same data in order to characterize key epidemiologic features of the disease. Applying the model to type-A hepatitis, we describe a new epidemic pattern of this disease. We introduce a new mathematical rationale for epidemic processes, and we provide a convenient framework for describing disease clusters.

1213 TRACHEOESOPHAGEAL FISTULA AND ESOPHAGEAL ATRESIA IN NORTH CAROLINA: A STUDY OF CLUSTERING AND POSSIBLE ASSOCIATION WITH INFECTIOUS DISEASE

Two hundred and eighty-five cases of esophageal atresia with or without tracheoesophageal fistula (TEF/EA) occurring in North Carolina between 1952 and 1978 have been studied. Except for an increase of low birth weight and hydramnios in the study group, the cases are demographically representative of the general population. Cases without other malformations (isolated TEF/EA) and cases with other associated anomalies were analyzed separately. No significant clustering was found for the latter group while clustering over time was statistically confirmed for isolated TEF/EA cases. The dominant period for isolated TEF/EA was 8.3 years. Data compiled on 20 infectious diseases by the state of North Carolina were analyzed. A predominant period of 8.3 years was found for infectious hepatitis. The phase of the frequency curve for infectious hepatitis appears to coincide with that of the TEF/EA curve. Although these data do not allow us to conclude that a strong association exists between infectious hepatitis during pregnancy and the formation of TEF/EA in the fetus, they do suggest that this relationship should be studied further.

A standardized ratio for measuring the "suddenness" of events with applications to the four leading causes of violent death and to certain birth defects

An index which provides a measure of abrupt or sudden change in epidemic trends is provided. Using this index a simple comparison of the epidemiology of deaths due to homicides suicides motor vehicle accidents and other accidents [in a North Carolina city] is made. One example of the findings is that the trend in accidental deaths over recent years possesses more spontaneity or temporal clustering than the trend in violent nonaccidental deaths. Another application reveals an informative epidemiologic feature of the birth defects tracheoesophageal fistula and esophageal atresia. Implications of such findings are considered. (EXCERPT)