Birth cohort effects in neurological diseases: amyotrophic lateral sclerosis, Parkinson's disease and multiple sclerosis.

BACKGROUND: Generational differences in disease rates are the main subject of age-period-cohort (APC) analysis, which is mostly applied in cancer and suicide research. This study applied APC analysis to selected neurological diseases: amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD) and multiple sclerosis (MS). METHODS: The analyses were based on Swiss mortality data. Age-stratified data has been available for MS, PD and ALS since 1901, 1921, and 1942, respectively. APC analysis was performed within the framework of logit models. Main effect models were extended by implementing nested effects, i.e. age effects nested in subperiods, in order to account for the fact that age profiles may change for reasons other than generational influences. RESULTS: In preliminary analyses, APC analysis yielded noteworthy birth cohort effects in all three diseases. After implementing nested effects, the birth cohort effects disappeared in ALS, and smoothed out in PD, where they were greater for the generations born before the 1920s. In MS, the birth cohort effects remained stable, and exhibited a peak in cohorts born in the 1910s and 1920s. CONCLUSIONS: APC analysis yielded some evidence for birth cohort effects, i.e. predisposing risk factors that may change in historical terms, in MS and PD, but probably not in ALS.

Characteristics and Outcome in Acute Coronary Syndrome Patients with and without Established Modifiable Cardiovascular Risk Factors: Insights from the Nationwide AMIS Plus Registry 1997-2010.

OBJECTIVES: Little is known about patients without known modifiable risk factors presenting initially with acute coronary syndrome (ACS). This study assessed baseline characteristics and outcomes of ACS patients with and without the known modifiable risk factors arterial hypertension, dyslipidemia, obesity, smoking or diabetes. METHODS: All ACS patients enrolled in the AMIS Plus Registry between 1997 and 2010 were analyzed until hospital discharge; a subgroup was re-assessed at the 1-year follow-up. Outcome measures were in-hospital mortality and major adverse cardiac or cerebrovascular events (MACCE) defined as a composite outcome of mortality, re-infarction and cerebrovascular events. RESULTS: Of 33,306 patients, 2,125 (6.4%) had none of these modifiable risk factors. They were older (males), had less moderate or severe comorbidities and were more frequently in Killip class I on admission. Treatment of ACS patients with or without modifiable risk factors was similar with regard to interventional therapies and use of antiplatelet agents. In-hospital mortality was lower in patients without modifiable risk factors but in-hospital MACCE and 1-year survival was similar. CONCLUSION: Lack of modifiable risk factors was an independent predictor of lower in-hospital mortality but not of MACCE in patients who presented with ACS.

Persistent work-life conflict and health satisfaction - a representative longitudinal study in Switzerland.

BACKGROUND: The objectives of the present study were (1) to track work-life conflict in Switzerland during the years 2002 to 2008 and (2) to analyse the relationship between work-life conflict and health satisfaction, examining whether long-term work-life conflict leads to poor health satisfaction. METHODS: The study is based on a representative longitudinal database (Swiss Household Panel), covering a six-year period containing seven waves of data collection. The sample includes 1261 persons, with 636 men and 625 women. Data was analysed by multi-level mixed models and analysis of variance with repeated measures. RESULTS: In the overall sample, there was no linear increase or decrease of work-life conflict detected, in either its time-based or strain-based form. People with higher education were more often found to have a strong work-life conflict (time- and strain-based), and more men demonstrated a strong time-based work-life conflict than women (12.2% vs. 5%). A negative relationship between work-life conflict and health satisfaction over time was found. People reporting strong work-life conflict at every wave reported lower health satisfaction than people with consistently weak work-life conflict. However, the health satisfaction of those with a continuously strong work-life conflict did not decrease during the study period. CONCLUSIONS: Both time-based and strain-based work-life conflict are strongly correlated to health satisfaction. However, no evidence was found for a persistent work-life conflict leading to poor health satisfaction.

Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial.

BACKGROUND: Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care. METHODS: Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls). Men and women presenting in 68 primary care practices in Zurich County (Switzerland) with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups. RESULTS: The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002), as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002). All three biomarker tests showed good sensitivity and specificity. CONCLUSION: POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients. TRIAL REGISTRATION: DRKS: DRKS00000709.

Lower mortality from coronary heart disease and stroke at higher altitudes in Switzerland.

BACKGROUND: Studies assessing the effect of altitude on cardiovascular disease have provided conflicting results. Most studies were limited because of the heterogeneity of the population, their ecological design, or both. In addition, effects of place of birth were rarely considered. Here, we examine mortality from coronary heart disease and stroke in relation to the altitude of the place of residence in 1990 and at birth. METHODS AND RESULTS: Mortality data from 1990 to 2000, sociodemographic information, and places of birth and residence in 1990 (men and women between 40 and 84 years of age living at altitudes of 259 to 1960 m) were obtained from the Swiss National Cohort, a longitudinal, census-based record linkage study. The 1.64 million German Swiss residents born in Switzerland provided 14.5 million person-years. Relative risks were calculated with multivariable Poisson regression. Mortality from coronary heart disease (-22% per 1000 m) and stroke (-12% per 1000 m) significantly decreased with increasing altitude. Being born at altitudes higher or lower than the place of residence was associated with lower or higher risk. CONCLUSIONS: The protective effect of living at higher altitude on coronary heart disease and stroke mortality was consistent and became stronger after adjustment for potential confounders. Being born at high altitude had an additional and independent beneficial effect on coronary heart disease mortality. The effect is unlikely to be due to classic cardiovascular disease risk factors and rather could be explained by factors related to climate.

High-intensity training increases spontaneous physical activity in children: a randomized controlled study.

OBJECTIVE: To test the hypothesis that resistance training may increase spontaneous physical activity in children. STUDY DESIGN: Two junior ice hockey teams were randomly assigned to unchanged training schedules (team ZSC, 21 boys; mean age, 13.2 years) or to participate twice weekly in guided resistance training for 4 months (team GCK, 25 boys; mean age, 13.4 years). Spontaneous physical activity energy expenditure (SpAEE; 3-axial accelerometry for 7 days), muscle strength, and body composition (dual energy x-ray absorptiometry) were measured at 0, 4, and 12 months. RESULTS: Baseline measures did not differ in the groups, except for higher leg and trunk strength in team ZSC. In the intervention group compared with the control group, SpAEE significantly (P < or = .02) increased at 4 months (+25.5% versus 0%) and 12 months (+13.5% versus -9.5%). Leg and arm strength increased because of training intervention; all other variables were unchanged. None of these variables correlated with changes in SpAEE. CONCLUSION: In boys who play ice hockey, spontaneous physical activity is inducible with resistance training; this effect seems to be independent of changes in body composition and strength. If this was confirmed in unselected children, resistance training might be a new strategy for childhood obesity prevention programs.

Smoking and psychiatric disorders: have subthreshold disorders been overlooked?

INTRODUCTION: The association between smoking and mental disorders has been confirmed by several studies using cross-sectional and retrospective designs. The present study illustrates the need for differentiating subthreshold psychiatric disorders in the analysis. METHODS: The analysis is based on cumulative ("lifetime") prevalences of mental disorders and smoking in the Zurich study. This is a longitudinal community study with a stratified sample of 591 participants and six interviews from 1979 to 1999. RESULTS: The percentage of lifetime smokers in the Zurich study was higher both in persons with a lifetime psychiatric diagnosis (72%) and in persons with subthreshold disorders (60%) than in those without any diagnosis (40%). DISCUSSION: The association between smoking and mental disorders turned out to be clearly stronger if subthreshold mental disorders were appropriately considered in the analyses. Constructing appropriate reference groups is as crucial for the analysis of mental disorders and their outcomes as constructing adequate diagnostic groups.

Establishing a follow-up of the Swiss MONICA participants (1984-1993): record linkage with census and mortality data.

BACKGROUND: To assess the feasibility and quality of an anonymous linkage of 1) MONICA (MONItoring of trends and determinants in CArdiovscular disease, three waves between 1984 and 1993) data with 2) census and mortality records of the Swiss National Cohort in order to establish a mortality follow-up until 2008. Many countries feature the defect of lacking general population cohorts because they have missed to provide for follow-up information of health surveys. METHODS: Record linkage procedures were used in a multi-step approach. Kaplan-Meier curves from our data were contrasted with the survival probabilities expected from life tables for the general population, age-standardized mortality rates from our data with those derived from official cross-sectional mortality data. Cox regression models were fit to investigate the influence of covariates on survival. RESULTS: 97.8% of the eligible 10,160 participants (25-74y at baseline) could be linked to a census (1990: 9,737; 2000: 8,749), mortality (1,526, 1984-2008) and/or emigration record (320, 1990-2008). Linkage success did not differ by any key study characteristic. Results of survival analyses were robust to linkage step or certainty of a correct link. Loss to follow-up between 1990 and 2000 amounted to 4.7%. MONICA participants had lower mortality than the general population, but similar mortality patterns, (e.g. variation by educational level, marital status or region). CONCLUSIONS: Using anonymized census and death records allowed an almost complete mortality follow-up of MONICA study participants of up to 25 years. Lower mortality compared to the general population was in line with a presumable 'healthy participant' selection in the original MONICA study. Apart from that, the derived data set reproduced known mortality patterns and showed only negligible potential for selection bias introduced by the linkage process. Anonymous record linkage was feasible and provided robust results. It can thus provide valuable information, when no cohort study is available.

Impact of osteosynthesis in fracture care: a cost comparison study.

Aim: To estimate the health economic impact of osteosynthesis (OS) in fracture care over six decades in 17 high-income countries. Patients & methods: Applying a decision tree model, we assumed a hypothetical absence of OS and compared OS (intervention) with conservative treatment (CONS; comparator). We included patients with femur, tibia and radius fractures (age <65 years) and for proximal femur fractures also elderly patients (≥70 years). Results: We estimated savings in direct and indirect costs of 855 billion Swiss francs in the working age population in addition to 4.6 million years of life gained. In the elderly population, 69 billion Swiss francs were saved in direct costs of proximal femur fractures in addition to 73 million years of life gained. Conclusion: OS contributed to maximize health gains of society.

Attitudes of couples towards the destination of surplus embryos: results among couples with cryopreserved embryos in Switzerland.

BACKGROUND: The purpose of this study was to investigate attitudes towards the donation of surplus embryos among couples with cryopreserved embryos/zygotes, and to identify correlates associated with attitudes toward the destinations of surplus embryos/zygotes. METHODS: Eleven of 19 Swiss in vitro fertilization (IVF) centers in existence in 2004 participated in the survey. Questionnaires were sent to 888 eligible couples; 458 men (52%) and 468 women (53%) returned them. RESULTS: Fifty-two percent of the participants supported the donation of surplus embryos to other couples, but divided opinions on the disclosure of biological parents' identities were identified. About 70% of participants indicated that donations of surplus embryos for medical research or therapy should be allowed, following strict regulations. Multiple logistic regression analyses revealed couples' position on the moral status of an embryo as the strongest predictor of attitudes toward all destinations of surplus embryos. Having children due to IVF/Intra-Cytoplasmic Sperm Injection (ICSI) treatment was negatively associated with attitudes towards donations to other couples. Perceived importance of religion, age >40, being a resident of the French-speaking region and unsuccessful IVF/ICSI treatment experiences were predictive of supporting donations for medical research. CONCLUSIONS: Swiss couples with cryopreserved embryos/zygotes are open to different options related to donating, rather than discarding, surplus embryos.

Work-life conflict and associations with work- and nonwork-related factors and with physical and mental health outcomes: a nationally representative cross-sectional study in Switzerland.

BACKGROUND: The aim of the present cross-sectional study was to examine work- and nonwork- related factors and physical and mental health outcomes associated with combined time- and strain-based work-life conflict (WLC) among adult employees living and working in Switzerland as well as possible gender differences in this regard. METHODS: The data used for the study were taken from wave 6 of the nationally representative Swiss Household Panel (SHP) collected in 2004. The analysis was restricted to 4'371 employees aged 20 to 64 years. Trivariate crosstabulations and multivariate linear and logistic regression analyses stratified by gender were performed in order to calculate gender-specific prevalence rates (%), beta coefficients (beta) and crude as well as multiple adjusted odds ratios (OR) as measures of association. RESULTS: Every eighth person (12.5%) within the study population has a high or very high WLC score. Prevalence rates are clearly above average in men and women with higher education, in executive positions or managerial functions, in full-time jobs, with variable work schedules, regular overtime, long commuting time to work and job insecurity. Working overtime regularly, having variable work schedules and being in a management position are most strongly associated with WLC in men, whereas in women the level of employment is the strongest explanatory variable by far, followed by variable work schedules and high job status (managerial position). In both men and women, WLC is associated with several physical and mental health problems. Employees with high or very high WLC show a comparatively high relative risk of self-reported poor health, anxiety and depression, lack of energy and optimism, serious backache, headaches, sleep disorders and fatigue. While overall prevalence rate of (very) high WLC is higher in men than in women, associations between degrees of WLC and most health outcomes are stronger in women than in men. CONCLUSION: This important issue which up to now has been largely neglected in public health research needs to be addressed in future public health research and, if the findings are confirmed by subsequent (longitudinal) studies, to be considered in workplace health promotion and interventions in Switzerland as elsewhere.

The impact of the AO Foundation on fracture care: An evaluation of 60 years AO Foundation.

OBJECTIVES: Sixty years ago, the Association of Osteosynthesis (AO) was founded with the aim to improve fracture treatment and has since grown into one of the largest medical associations worldwide. Aim of this study was to evaluate AO's impact on science, education, patient care and the MedTech business. DESIGN/METHODS: Impact evaluations were conducted as appropriate for the individual domains: Impact on science was measured by analyzing citation frequencies of publications promoted by AO. Impact on education was evaluated by analyzing the evolution of number and location of AO courses. Impact on patient care was evaluated with a health economic model analyzing cost changes and years of life gained through the introduction of osteosynthesis in 17 high-income countries (HICs). Impact on MedTech business was evaluated by analyzing sales data of AO-associated products. RESULTS: Thirty-five AO papers and 2 major AO textbooks are cited at remarkable frequencies in high ranking journals with up to 2000 citations/year. The number of AO courses steadily increased with a total of 645'000 participants, 20'000 teaching days and 2'500 volunteer faculty members so far. The introduction of osteosynthesis saved at least 925 billion Swiss Francs [CHF] in the 17 HICs analyzed and had an impact on avoiding premature deaths comparable to the use of antihypertensive drugs. AO-associated products generated sales of 55 billion CHF. CONCLUSION: AO's impact on science, education, patient care, and the MedTech business was significant because AO addressed hitherto unmet needs by combining activities that mutually enriched and reinforced each other.

Association between short sleeping hours and physical activity in boys playing ice hockey.

OBJECTIVES: To determine physical activity in healthy boys and how physical activity relates to training and daily awake hours. STUDY DESIGN: In 66 boys (5 to 15 years) affiliated with an ice-hockey club, we measured total daily energy expenditure (TDEE, doubly-labeled water) and basal metabolic rate (ventilated-hood method). Physical activity energy expenditure for the whole day (DAEE), during training, and during spontaneous physical activity was measured by accelerometry and activity protocols. Univariate (UA) and multivariate (MA) correlation analysis was applied. RESULTS: Physical activity level, DAEE, and TDEE for prepubertal (2.0 and 2.2 Mcal/d) and pubertal (bone age >or=13 years; 1.8 and 2.8 Mcal/d) boys were matched to literature data from normal boys of equal age. In prepubertal boys DAEE correlated positively with awake hours (r(UA) = 0.55, r(MA) = 0.39, P < .01). In pubertal boys this correlation was not significant, the slopes between the 2 groups being significantly different (P = .025). In prepubertal boys spontaneous physical activity expenditure correlated significantly positively with training activity expenditure (r(UA) = 0.72, r(MA) = 0.52, P < .001). CONCLUSION: Contrary to findings in adults, where short sleepers had lower physical activity and intensive training was negatively compensated reducing spontaneous physical activity, in physically active prepubertal boys, total daily and spontaneous physical activity relate positively to awake hours and training; suggesting child-specific control of physical activity.

Methods of suicide: international suicide patterns derived from the WHO mortality database.

OBJECTIVE: Accurate information about preferred suicide methods is important for devising strategies and programmes for suicide prevention. Our knowledge of the methods used and their variation across countries and world regions is still limited. The aim of this study was to provide the first comprehensive overview of international patterns of suicide methods. METHODS: Data encoded according to the International Classification of Diseases (10th revision) were derived from the WHO mortality database. The classification was used to differentiate suicide methods. Correspondence analysis was used to identify typical patterns of suicide methods in different countries by providing a summary of cross-tabulated data. FINDINGS: Poisoning by pesticide was common in many Asian countries and in Latin America; poisoning by drugs was common in both Nordic countries and the United Kingdom. Hanging was the preferred method of suicide in eastern Europe, as was firearm suicide in the United States and jumping from a high place in cities and urban societies such as Hong Kong Special Administrative Region, China. Correspondence analysis demonstrated a polarization between pesticide suicide and firearm suicide at the expense of traditional methods, such as hanging and jumping from a high place, which lay in between. CONCLUSION: This analysis showed that pesticide suicide and firearm suicide replaced traditional methods in many countries. The observed suicide pattern depended upon the availability of the methods used, in particular the availability of technical means. The present evidence indicates that restricting access to the means of suicide is more urgent and more technically feasible than ever.

Reduction in the suicide rate during Advent--a time series analysis.

Research has shown that there are different seasonal effects in suicide. The aim of this study is to demonstrate that the decrease in suicide rate at the end of the year is extended over the last weeks of the year and represents a specific type of seasonal effect. Suicide data were extracted from individual records of the Swiss mortality statistics, 1969-2003. The data were aggregated to daily frequencies of suicide across the year. Specifically, the period October-February was examined using time-series analysis, i.e., the Box-Jenkins approach with intervention models. The time series models require a step function to account for the gradual drop in suicide frequencies in December. The decrease in suicide frequencies includes the whole Advent and is accentuated at Christmas. After the New Year, there is a sharp recovery in men's suicide rate but not in women's. The reduction in the suicide rate during the last weeks of the year exceeds the well-recognised effect of reduced rates on major public holidays. It involves valuable challenges for suicide prevention such as timing of campaigns and enhancement of social networks.

Admission glycaemia and outcome in patients with acute coronary syndrome.

Some studies of patients with acute myocardial infarction have reported that hyperglycaemia at admission may be associated with a worse outcome. This study sought to evaluate the association of blood glucose at admission with the outcome of unselected patients with acute coronary syndrome (ACS). Using the Acute Myocardial Infarction and unstable angina in Switzerland (AMIS Plus) registry, ACS patients were stratified according to their blood glucose on admission: group 1: 2.80-6.99 mmol/L, group 2: 7.00-11.09 mmol/L and group 3: > 11.10 mmol/L. Odds ratios for in-hospital mortality were calculated using logistic regression models. Of 2,786 patients, 73% were male and 21% were known to have diabetes. In-hospital mortality increased from 3% in group 1 to 7% in group 2 and to 15% in group 3. Higher glucose levels were associated with larger enzymatic infarct sizes (p<0.001) and had a weak negative correlation with angiographic or echographic left ventricular ejection fraction. High admission glycaemia in ACS patients remains a significant independent predictor of in-hospital mortality (adjusted OR 1.08; 95% confidence intervals [CI] 1.05-1.14, p<0.001) per mmol/L. The OR for in-hospital mortality was 1.04 (95% CI 0.99-1.1; p=0.140) per mmol/L for patients with diabetes but 1.21 (95% CI 112-1.30; p<0.001) per mmol/L for non-diabetic patients. In conclusion, elevated glucose level in ACS patients on admission is a significant independent predictor of in-hospital mortality and is even more important for patients who do not have known diabetes.

Epidemiology and pathophysiology of obesity as cause of cancer.

According to World Health Organisation estimates 1.1 billion people were overweight or obese worldwide in the year 2000 with the prevalence rapidly increasing. Compelling evidence suggests that excess body weight is a risk factor for several cancer types including cancer of the colon, breast, endometrium, kidney, oesophagus, as well as possibly additional sites. According to previous meta-analyses and systematic literature reviews, an important proportion of cancer has been estimated to be attributable to excess body weight. The extrapolation of a European meta-analysis [1] to the Swiss situation broadly estimates that around 700 cancers could be prevented in the absence of overweight and obesity in this country. The data presented highlights the public health relevance of preventing excess body weight. Several interacting metabolic and hormonal pathways seem to underlie the association between being overweight and cancer with insulin-resistance playing a central role. Since evidence is mounting that excess body weight can also adversely affect cancer prognosis, obesity is a primary target for cancer control programs.

Epidemiology of aphasia attributable to first ischemic stroke: incidence, severity, fluency, etiology, and thrombolysis.

BACKGROUND AND PURPOSE: In a geographically defined population, we assessed incidence and determinants of aphasia attributable to first-ever ischemic stroke (FEIS). METHODS: A 1-year prospective, population-based study among the permanent residents of the canton Basle City, Switzerland, was performed using multiple overlapping sources of information. RESULTS: Among 188,015 inhabitants, 269 patients had FEIS, of whom 80 (30%; 95% CI, 24 to 36) had aphasia. The overall incidence rate of aphasia attributable to FEIS amounted to 43 per 100,000 inhabitants (95% CI, 33 to 52). Aphasic stroke patients were older than nonaphasic patients. The risk of aphasia attributable to FEIS increased by 4% (95% CI, 1% to 7%), and after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%) with each year of patients' age. Gender had no effect on incidence, severity, or fluency of aphasia. Cardioembolism was more frequent in aphasic stroke patients than in nonaphasic ones (odds ratio [OR], 1.85; 95% CI, 1.07 to 3.20). Aphasic patients sought medical help earlier than nonaphasic stroke patients. Still, after controlling for stroke onset-assessment interval, aphasic stroke patients were more likely to receive thrombolysis than nonaphasics (OR, 3.5; 95% CI, 1.12 to 10.96). CONCLUSIONS: Annually, 43 of 100,000 inhabitants had aphasia resulting from first ischemic stroke. Advancing age and cardioembolism were associated with an increased risk for aphasia. Severity and fluency of aphasia were not affected by demographic variables.

Incidence of first-ever ischemic stroke in the Canton Basle-City, Switzerland: a population-based study 2002/2003.

Our study sought to estimate the incidence rate of first-ever ischemic stroke (FEIS) in the geographically well-defined population of the Canton Basle-City, Switzerland. An one-year prospective population-based study among the permanent residents of the Canton Basle-City (188015 inhabitants, census 2002) was carried out. Multiple overlapping sources of information were used. Stroke was defined according to the WHO criteria. The diagnosis of FEIS was based on clinical assessment and neuroimaging findings. 269 patients (114 males; mean age 72.8, standard deviation (SD) +/- 12 and 155 females; mean age 78.4, SD +/- 11) with FEIS were identified. The overall crude incidence of FEIS amounted to 143 per 100000 population (95% confidence interval (CI) 126 to 160) and it was higher among females (156; 95% CI 132 to 181) than in males (128; 95% CI 105 to 152). The age-specific incidence rates of FEIS approximately doubled with each decade of life, increasing from 17 (95 % CI 2 to 31) among 0-44 years old group to 1034 (95% CI 774 to 1293) for those aged 85 or more years. The overall incidence rate of FEIS adjusted for age to the European standard population was 76 per 100000 inhabitants (95% CI 66 to 86) and it was higher in males-89, 95% CI 72-106-than in females-66, 95 % CI 53-77. Moreover, in comparison with studies from other developed countries (e. g. Germany, Italy, Australia)-carried out in the middle of 1990s-the standardised incidence rates of FEIS were substantially lower in Switzerland. Our results indicate that the risk of ischemic stroke might be low in Switzerland. However, giving a major reduction in the age and gender specific stroke incidence over the past years our findings might-alternatively-mirror this favourable trend.