Background and Purpose-In a geographically defined population, we assessed incidence and determinants of aphasia attributable to first-ever ischemic stroke (FEIS). MethodsA 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). Conclusion-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.

OBJECTIVE: To explore the relationship between hypercholesterolaemia, age and BMI among females and males. DESIGN: Population-based cross-sectional survey. SUBJECTS: The data came from the initial surveys of the WHO MONICA Project. In all, 27 populations with 48 283 subjects (24 017 males and 24 266 females) aged 25-64 y were used for the analysis. MEASUREMENTS: Total cholesterol, weight, height, BMI, prevalence of hypercholesterolaemia (PHC) defined as cholesterol Z6.5 mmol/l, and the prevalence of obesity (POB) defined as BMI Z30 kg/m 2 . RESULTS: PHC increased with age, with PHC in males being significantly higher than in females at age range 25-49 y and significantly lower than in females at age range 50-64 y. Age-related increase in hypercholesterolaemia was steeper in females than in males. There was a statistically significant positive association between hypercholesterolaemia and BMI. Multiple logistic regression analysis revealed a negative statistically significant (Po0.001) effect modification involving age and BMI on the risk of having hypercholesterolaemia both in females and males. The relation between PHC and BMI became weaker in higher age groups, with no statistically significant association in females aged 50-64 y. CONCLUSION: Public health measures should be directed at the prevention of obesity in young adults since the strongest effect of obesity on the risk of hypercholesterolaemia has been found in subjects aged 25-39 y.

Background: Recent research has corroborated the notion that seasonality in suicide is more heterogeneous and less consistent than postulated by former scholars. This work investigates the smoothing out of suicide seasonality in Switzerland between the late 19th and the end of the 20th century. It includes analyses by region and by suicide method. Methods: Monthly suicide frequencies in Switzerland are available for the period 1876-2000. Data on canton/region are available for the periods 1901-1920 and 1969-2000, and data on suicide method for the periods 1881-1920 and 1969-2000. Analyses focusing on the overall change rely on data aggregated by quinquennia. The Edwards' test and the peak-low ratio were used in univariate analyses of seasonality. Putative determinants of the peak-low ratio were examined using regression analysis with cantonal data. Results: The decrease of seasonal effects in suicide applies to a period of more than 100 years in Switzerland. Big differences of seasonal effects have existed all the time with regard to specific methods and to specific regions. No seasonality was apparent in poisoning, and in Geneva and Basle City, respectively. However, the seasonal effects have been most impressive in drowning and hanging suicides, and in rural Catholic regions. In regression analysis, the decline in suicide seasonality is associated with the decline in the agricultural work force. Conclusions: The smoothing out of suicide seasonality in Switzerland has been a continuous long term process, which probably started by the end of 19th century. Seasonal effects in suicide will probably fade away in most regions of Switzerland and in most suicide methods. This process is in parallel with the disappearance of the traditional rural society.

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.

Objective: Barriers to thrombolysis are rather assessed for hospitalized stroke patients than among geographically defined populations. In a population-based approach, we assessed (1) the utilization rate of stroke thrombolysis in the community, and (2) the significance of the chosen stroke care provider as a potential barrier to thrombolysis. Methods: We performed a databank-based post hoc analysis, derived from data ascertained in a prospective, population-based stroke study among the permanent residents of the canton Basel-City, Switzerland. For the cohort with an onset assessment interval (OAI) ≤3 h, we compared thrombolyzed with nonthrombolyzed patients concerning demographic variables, the National Institutes of Health stroke scale (NIHSS) score, OAI, risk factors, and the type of stroke care provider. For patients without thrombolysis despite an OAI ≤3 h, barriers to thrombolysis were compiled. Results: Among 269 patients, 49 had an OAI ≤3 h (18% of all patients and 38% of those 128 patients with exactly known time of onset). Fourteen patients received thrombolysis, amounting to a utilization rate of 5.2% (95% CI 2.9–8.6) for all patients and 29% (95% CI 17–43) for the OAI ≤3-hour cohort. For the latter, thrombolyzed differed from nonthrombolyzed patients in higher NIHSS score and type of stroke care provider, but not in demographic variables, OAI, or risk factors. Fourteen of 40 patients (35%) primarily admitted to the stroke unit received thrombolysis, compared with none of 9 patients primarily treated elsewhere (p < 0.04). In the OAI ≤3-hour cohort, mild or regressing stroke severity (48%), admission to hospitals not offering thrombolysis (20%), computed tomography or laboratory contraindications (17%) and severe comorbidity (14%) were barriers to thrombolysis. Conclusion: In this geographically defined population, every 20th stroke patient received thrombolysis. Only a minority of patients had an OAI ≤3 h, rendering late admission the most common barrier to thrombolysis. In the OAI ≤3-hour cohort, admission to hospitals not offering thrombolysis prompted exclusion from thrombolysis as often as established contraindications. Thus, acute stroke patients should solely be brought to hospitals providing thrombolysis.

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Data for this analysis came from a cross-sectional study on dementia, depression, and disability conducted in Zurich and Geneva in 1995/96. The random sample stratified by age and gender consisted of 921 subjects aged 65 and more. Based on the Canberra Interview for the Elderly, depression was assessed by means of psychogeriatric assessment scales (PAS) according to DSM-III-R criteria. The number of depressive symptoms (NDS) and the prevalence rate of depression (PRD) were computed for the whole sample as well as according to age and gender. To evaluate the independent effects of age as well as gender with regard to the risk of being depressed, multivariate analyses were conducted. On average, 13% of females vs 8% of males reported having at least one depressive symptom. The PAS yielded 298 (41.8%) subjects without depressive symptoms, 341 (50.2%) with 1-3 symptoms, and 60 (8.0%) with four or more. The average NDS was 1.27 (95% CI 1.16-1.39). For females, NDS values statistically significantly higher than those for males were calculated (1.53, 95% CI 1.35-1.70 vs 1.05, 95% CI 0.90-1.20). The NDS increased significantly with age. Subjects with low education levels and being divorced or widowed had statistically significantly higher NDS values than highly educated, married, or single persons. There were strong positive associations between NDS, dementia, and activities of daily living. Multivariate regression analysis revealed gender - however, not age - as a strong risk factor for NDS. Overall PRD amounted to 8.0% (95% CI 5.7-10.2%). Females had statistically significantly higher PRD values than males (10.4%, 95% CI 7.0-13.9% vs 3.9, 95% CI 2.0-5.9%). The PRD increased substantially with age. After adjustment for other risk factors, multivariate logistic regression analysis confirmed the positive statistically significant association between age, gender, and depression.

Current research is yielding an increasingly heterogeneous picture of suicide seasonalities: They seem to depend on methods and, moreover, they seem to have smoothed in recent decades. This work examines the latter issue by comparing suicide seasonalities in the canton of Zurich, Switzerland, in the 16 th -18 th centuries, 1901-1920 and 1969-94. The results indicate shifts of peaks and lows on suicide seasonalities over the centuries, with a smoothing of seasonalities toward the 21 th century. The recent period does not show any suicide seasonality at all. The canton of Zurich seems to be ahead of the general trend found in other regions of Switzerland.