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Objective To investigate the incidence of allergic and respiratory diseases through age 3 years in children fed docosahexaenoic acid (DHA)- and arachidonic acid (ARA)-supplemented formula during infancy. Study design Children who completed randomized, double-blind studies of DHA/ARA-supplemented (0.32%-0.36%/0.64%-0.72% of total fatty acids, respectively) versus nonsupplemented (control) formulas, fed during the first year of life, were eligible. Blinded study nurses reviewed medical charts for upper respiratory infection (URI), wheezing, asthma, bronchiolitis, bronchitis, allergic rhinitis, allergic conjunctivitis, otitis media, sinusitis, atopic dermatitis (AD), and urticaria. Results From the 2 original cohorts, 89/179 children participated; 38/89 were fed DHA/ARA formula. The DHA/ARA group had significantly lower odds for developing URI (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.08-0.58), wheezing/asthma (OR, 0.32; 95% CI, 0.11-0.97), wheezing/asthma/AD (OR, 0.25; 95% CI, 0.09-0.67), or any allergy (OR, 0.28; 95% CI, 0.10-0.72). The control group had significantly shorter time to first diagnosis of URI ( P = .006), wheezing/asthma ( P = .03), or any allergy ( P = .006). Conclusions DHA/ARA supplementation was associated with delayed onset and reduced incidence of URIs and common allergic diseases up to 3 years of age.

Objective The purpose of this study was to test whether vasculopathy in type 1 diabetes mellitus (DM) is associated with fetal growth abnormalities. Study Design Women with type 1 DM (n = 340) were enrolled in a prospective study of diabetes in pregnancy and classified according to vascular status: NV (no vasculopathy, n = 181), HBR (hypertension or background retinopathy, n = 79), PR (proliferative retinopathy only, n = 16), NEP (nephropathy only, n = 40), and PRN (proliferative retinopathy and nephropathy, n = 24). Association of vascular status with low birthweight (LBW) and small for gestational age (SGA) infants was analyzed. Results The odds ratios for delivery of a LBW infant compared to women without vasculopathy after controlling for maternal age, gestational age and race were: HBR 1.0, PR 2.2, NEP 3.7, and PRN 5.5. The odds ratios for delivery of a SGA infant were: HBR 0.7, PR 10.4, NEP 1.9, and PRN 9.9. Conclusion Diabetic vasculopathy is associated with increased odds for delivery of low-birthweight or SGA infants.

27 Introduction: We report a planned midpoint analysis of a prospective, population-based, case-control study of the genetic and environmental risk factors of spontaneous, non-traumatic, intracerebral hemorrhage (ICH). Methods: Cases were matched to two controls by age, race and gender. Data was obtained by direct interview and review of all available medical and neuroimaging data. Apolipoprotein E (Apo E)genotype was determined by polymerase chain reaction. Multivariable analyses were performed using logistic regression modeling. Results: Between 6/97 and 2/00, 189 cases of ICH (150 white/39 black; 68 lobar/121 non-lobar) and 368 controls were enrolled into the study. Independent risk factors for multivariable analysis are listed in the table. Only prior stroke was an independent risk factor for both lobar and non-lobar ICH. Conclusions: The importance of individual genetic and environmental risk factors for ICH vary substantially by location of ICH. A history of a first-degree relative with ICH was associated with an increased risk of lobar ICH, independent of Apo E genotype. This finding indicates that other genetic risk factors may be important in the development of ICH.

69 Background and Purpose: Smoking is a strong independent environmental risk factor for stroke. We sought to prospectively examine the impact of the diagnosis of stroke on smoking behavior at three months. Design : Patients admitted to 17 hospitals in the Greater Cincinnati area with a confirmed diagnosis of stroke were interviewed in the acute period after their event. A standardized questionnaire was utilized to collect detailed smoking history. Risk factor reduction was discussed with the patient and/or family members and printed risk reduction information was provided. Patients or their proxies were then contacted at three months and current smoking status was recorded. Results: Of 365 stroke patients, 99 were current smokers at baseline. There were no differences between the smokers and the non-smokers based on gender, race, age, and education. At three months, 44% of the baseline smokers had quit smoking (p Conclusions: After a stroke, patients are motivated to change smoking behavior, as has been found with other life threatening diagnoses. Longer follow-up is needed to see if this behavior continues.

24 Background: We have previously estimated the stroke incidence rate in the US to be 731,000/yr using data from blacks in Cincinnati and whites in Rochester, MN. We present preliminary stroke incidence rates using data from white and black residents of the Greater Cincinnati metropolitan area. Methods: All strokes between 1/1/93–6/30/94 for blacks and 7/1/93–6/30/94 for whites were identified by surveillance of ICD-9 discharge codes from hospitals (430–438, 1 o or 2 o ), coroner’s records, and surveillance of outpatient settings including emergency departments, hospital based outpatient clinics, family practice centers, and a random sampling of primary care offices and nursing homes. More than 17,000 potential stroke/TIA events were screened. During abstraction, research nurses determined stroke subtype, using strict criteria. Overall agreement on stroke subtype and diagnosis between study nurses and physicians is 87% (κ = 0.71). The incidence rates per 100,000 for stroke were calculated and standardized to the 1990 total U.S. population. Results: Rates of first-ever stroke among blacks were consistently higher than rates for whites for all stroke subtypes (Table). The overall rate of first-ever and recurrent stroke was 291 per 100,000. Conclusion: Based on these incidence rates, derived from a large, population-based study, we estimate that 760,000 strokes will occur in the US in the year 2000.

P141 Background: Subarachnoid hemorrhage (SAH) affects ≥ 16,000 Americans annually and ≥ 40% die within the first 30 days. Prevention of SAH is therefore of paramount importance. We present a preliminary analysis of risk factors for SAH from our case-control, population-based study. Methods: Cases were prospectively collected and matched to 2 age-, race-, and gender-matched controls. Risk factor history, family history, neuroimaging data, and genetic samples were obtained. Multivariable analysis was performed using logistic regression. Results: Between 6/97 and 2/00, 107 cases and 197 controls were enrolled in this study. By univariate analysis: hypertension, family history of SAH or intracranial aneurysm (IA), smoking (current or ever), alcohol use, low education level, low body mass index (BMI), and low estrogen state were risk factors for SAH (p < 0.05). Results of the multivariable analysis are presented below. Conclusion: Our data confirms previous reports that SAH is a heritable condition. Further work must be done to identify the genetic basis of SAH, so that families can be screened in an efficient and cost effective way. Risk for SAH may be reduced by treating hypertension, smoking cessation, and reduced alcohol intake. The importance of low BMI as a risk factor has been previously reported but is biologically puzzling and requires further study.

124 Introduction: Early hemorrhage growth and clinical deterioration has been shown to occur in at least 25% of patients with spontaneous ICH. This study investigated potential baseline clinical factors associated with early hemorrhage growth in spontaneous ICH patients. Methods: We performed a post-hoc analysis of a prospective observational study of patients with spontaneous ICH within 3 hours of onset. CT scans were performed at presentation and 1 hour. Demographic variables (diabetes, smoking, hypertension, alcohol use, and antiplatelet medication) and clinical variables [systolic and diastolic blood pressure (SDP, DBP), mean arterial pressure (MAP), pulse pressure(PP) and combinations of these with heart rate (HR)] were analyzed using univariate analyses. Principle components analysis and logistic regression modeling were also performed. Results: Complete data sets were available for 97 of the 103 patients. Univariate analyses of demographic and clinical variables failed to identify an association with those patients who experienced hemorrhage growth in the first hour of management. Multivariate and multivariable analyses similarly failed to identify factors associated with early hemorrhage growth (Table 1). Conclusion: No single demographic or clinical variable or combination increased risks of early hemorrhage growth. Specifically, no blood pressure or heart rate parameter, individually or in combination, were associated with early ICH growth.

P146 Intro: The Greater Cincinnati/Northern Kentucky Stroke Study provides epidemiologic data regarding stroke in blacks and whites. We present the incidence rates of ischemic stroke in diabetics. Methods: All strokes occurring between 1/1/93–12/31/93 for blacks and 7/1/93–12/31/93 for whites were identified by suveillance of ICD-9 discharge codes from hospitals (430–438, 1 o or 2 o ), coroner’s records, and surveillance of outpatient settings previously described (Stroke 31; 280, 2000) . Patient-medical encounters for all possible strokes/TIAs were reviewed and abstracted by a study nurse who determined diagnosis and stroke subtype using strict criteria (agreement with study physicians=87%, κ=0.71 on records completed by MD’s to date). For calculating incidence rates, the numerator consisted of cases determined to be a stroke by the study nurse. The denominator was calculated using self-reported age and gender specific rates of diabetes obtained from a 1995 random-digit dialing survey of 1850 study area residents proportionate to the stroke population (JAMA 279:1288–1292;1998 ). Reported incidence rates are adjusted to the 1990 US population. Conclusion: A preliminary analysis of our population-based study data reveals that diabetics have approximately a three-fold higher incidence of stroke as compared to non-diabetics, with slightly higher relative risk for whites. Diabetes is thus an important risk factor for ischemic stroke in both races although the prevelance of diabetes is higher in blacks.

P166 Introduction: Our hypothesis is that the total time between a 911 call and arrival at the Emergency Department (ED)(EMS time) varies by the socio-demographics of a stroke patient’s ZIP code, controlling for distance to the ED (EMS distance). This study considers an urban African-American (AA) population. Methods: We identified all hospitalized and autopsied strokes/TIAs between 1/1/93 and 6/30/93 for AA residents in the Greater Cincinnati/ Northern Kentucky area. Address and timing of stroke and emergency care were abstracted from the medical chart. We obtained socio-demographic data for the ZIP code of residence from 1990 Census files: income, % AA, % on public assistance, and % below poverty. Location of residence and ED and estimation of EMS distance were calculated using ARCVIEW software. Linear regression was used for analysis. Results: Of 352 strokes, 268 occurred at home, 123 used EMS transport, and 81 had complete time data. Longer EMS time was associated with percent of the residents in the ZIP code on public assistance (p=.03), controlling for EMS distance (p=.02, Table). No other personal or socio-demographic attributes of the ZIP code were significant. Conclusion: ZIP codes with a higher percentage of residents on public assistance had significantly longer EMS times than ZIP codes with a lower percentage. Issues that may influence this relationship will be discussed.

Background Phthalates, used in a variety of consumer products, are a group of chemicals that are ubiquitous in the environment, and their metabolites are detectable in most humans. Some phthalates have anti-androgenic properties; a prior study reported an association between gestational exposure to phthalates and reduced masculine behaviors in preschool boys. Methods Concentrations of 9 phthalate metabolites were measured in urine collected at 16 and 26 weeks’ gestation from pregnant women enrolled in the HOME Study, a prospective pregnancy and birth cohort. Measures of gender-related play were collected at 8 years of age, including the Gender Identity Questionnaire (GIQ) completed by mothers, and the Playmate and Play Style Preferences Structured Interview (PPPSI) completed by children. We examined these measures as continuous variables using both bivariate and multivariable approaches with adjustment for covariates. Additional analyses included logistic regression of GIQ and PPPSI scores dichotomized by sex at the lower 25th percentile, indicating the least typical behavior. Results Mothers’ phthalate metabolite concentrations during pregnancy were similar to the reported national average among US women. All children scored within a typical range on both measures of gender-related play behavior. No statistically significant associations were found between averaged maternal phthalate metabolite concentrations and continuous PPPSI scores or any GIQ scores. For the dichotomized PPPSI; higher maternal monoethyl phthalate (MEP) concentrations were associated with more typical play behaviors for females (OR = 0.70, CI = 0.51–0.97). In contrast, higher maternal mono-isobutyl phthalate (MiBP) concentrations were associated with higher odds of membership in the least typical play behaviors group for males (OR = 1.69, CI = 1.00–2.86). Conclusions In this sample of typically developing children, higher maternal urinary MEP concentrations during pregnancy were associated with more typical gender-related play behaviors in both males and females, and increased urinary MiBP concentrations were associated with less masculine gender-related play behaviors in males.