Epidemiological assessment of levodopa use in Cuba: 1993-1998.

PURPOSE: The purpose of this study is to describe and evaluate the use of levodopa in Cuba in order to provide a basis for intervention aimed at improving pharmacological treatment of individuals presenting with Parkinson's disease (PD). METHODS: We studied the amount of levodopa, both plain and combined, distributed by the central laboratory to hospital and community pharmacies in Cuba in the period 1993-1998. An internationally established drug-classification system and a reported method for epidemiological assessment of levodopa sales were applied. Sweden in 1994 served as the reference population. RESULTS: National crude rates of levodopa use basically remained stable since 1994, and in 1998 stood at 0.11 defined daily dose (DDD) per 1000 inhabitants/day, approximately 15 times lower than the corresponding figure for the reference population. Annual provincial use of levodopa showed considerable geographical variation, with the lowest rates in the eastern provinces and the highest rates in Havana City (Ciudad de La Habana). Adjustment for age reduced such differences by approximately 50%. CONCLUSIONS: Levodopa use in Cuba is low and consistent with the reported low prevalence of the diagnosis of PD. Results suggest that the diagnosis and treatment of PD can be improved, with emphasis on better detection of PD.

[Parkinson disease in Spain: evidence of under-diagnosis and starting points for its reduction]. / Enfermedad de Parkinson en España: evidencias de infradiagnóstico y puntos de partida para su reducción.

INTRODUCTION: Parkinson's disease (PD) has been found in all surveys focusing on frequent neurological disorders. In general, sparse geographical variation of PD prevalence was found. OBJECTIVE: Since preliminary data suggest considerable PD underdiagnosis, 69%, 67%, 52%, 29%, we studied potential differences of PD prevalences in Spain. MATERIAL AND METHODS: We obtained age-specific prevalences of PD from scientific media and publications from professional meetings and compared them using stratified analysis. RESULTS: The geographical variation of prevalences at ages 60-89 years was small except among those aged 80-89, being twofold in Cantalejo, Segovia, and approximately 1/3 in Lower Aragón, Teruel. The Cantalejo (door-to-door, 67% de novo diagnoses) versus Lower Aragón (medical services) prevalence ratio was 4/1. CONCLUSION: PD might be considerably underdiagnosed in Spain.

[Motoneuron disease in Spain: differential epidemiological features]. / Enfermedad de motoneurona en España: rasgos epidemiológicos diferenciales.

INTRODUCTION AND OBJECTIVES: Little data has been published in Spain on motor neurone disease or amyotrophic lateral sclerosis. This study reports data on incidence and mortality in Cantabria and incidence in Segovia. It discusses and compares them emphasizing certain characteristic features of the epidemiology of the disease in Spain. RESULTS: The incidence of motor neurone disease is higher in males, increases with age, reaches a peak between 70 and 79 years but then drops after the age of 80. There is little difference between incidence and mortality. The incidence of mortality varies greatly with time. CONCLUSIONS: The incidence of motor neurone disease in Spanish studies is average. The mortality is similar to that of other countries, although the pattern varies with age. There was a striking drop in this disease in the 1960s, but since 1970 it has been increasing.