Epidemiological assessment of levodopa use in Spain, 1990-1995. Persistent, low consumption in the south.

Parkinson's disease (PD) is considerably underdiagnosed in Spain and its treatment relies mainly on levodopa (LD), a drug enjoying good access country-wide. In order to identify regions with the highest potential for improvement in the quality of life of PD patients, we evaluated total sales of levodopa in Spanish provinces during the period 1990-1995, using a reported method. Total annual crude sales in the country were medium-low and increased with time. When adjusted for age and infant mortality rates (IMRs), taken as an index of socio-sanitary development, annual LD sales become stable and similar to those in the reference population, Sweden 1994. Provincial LD use (LDU) showed a wide variation in annual levels and time trends, with a north-south gradient in evidence. Statistically significant clustering was seen, with the lowest crude age-adjusted and age- and IMR-adjusted LD sales in the south-west and moderately high levels in north-central and north-west provinces. The results show that LDU in Spain is medium-low, and that demographic and social factors may underlie geographical differences in LD sales. The remarkably low LDU in selected provinces in the south-west of the country might reflect deficient PD detection and/or treatment amenable to control.

[Familial mixed hearing loss associated with X chromosome and stapedial gusher]. / Hipoacusia mixta familiar asociada al cromosoma X con gusher estapedial.

Perilymphatic and/or CSF loss through the oval window during stapedectomy is called a gusher. This rare disorder is associated with X-linked progressive mixed hearing loss. It is related with mutations in the POU3F4 gene at locus DFN3 on Xq21. Our study of the cases seen in our department yielded information and clinical and radiological findings that could be useful for the clinical management, early diagnosis, and prevention of erroneous therapeutic indications.

Drug utilization in community pharmacy.

Drug utilization studies are a powerful means of identifying problem areas in drug consumption. The defined daily dose/1,000 inhabitants/day (DHD), provides an estimate of the proportion of the population who receive drug treatment in ambulatory care at national, regional, local and institutional levels. A new unit and its formula has been developed; defined daily dose/100 consumers/day (DCD), for the determination of drug utilization from community pharmacy allocated in cities where it is difficult to estimate the population covered by each pharmacy. This formula was applied to a community pharmacy to obtain the utilization of drugs for peptic ulcer treatment in 1990 and 1991. The data are compared with regional DHD data and there is good agreement between the results of the two methods. Data on non-prescription drug utilization are not easily available, and community pharmacists could improve the information available for this groups of drugs through use of the proposed formula and unit.

Epidemiological assessment of levodopa use by populations.

This study is an analysis of the measurements of drug use by populations proposed by the Nordic Council on Medicines, conducted from an epidemiological-theoretical perspective. Particular attention is given to levodopa use (LDU). Several measurements of comparative LDU are proposed here for the assessment of levodopa (LD) consumption, from data on LD sales to well defined populations, over known periods of time. The method takes into account possible purposes of LDU evaluations, and is based on a reported model which combines information on Parkinson's Disease prevalence (PD) from surveys, gross levodopa sales, age-structure of the population, the figures for infant mortality rates (IMRs) taken as an indicator of modernization, and the average amount of LD prescribed as daily dose. The evaluation of LDU is implemented following a stepwise procedure.