A prevalence survey on Parkinson's disease (PD) was performed in the Republic of San Marino, which is the smallest independent state in the world, and is located near the Adriatic coast, within Italy. On April 30, 1986, it had a population of 22,322. We found 34 cases of PD (17 men, 17 women). Crude prevalence ratio per 100,000 population was 152 (154 for men, 150 for women) with an age-adjusted ratio of 185 (both sexes). This study shows that the prevalence of PD in the Mediterranean area of South Europe is similar to that in North Europe and the United States.

SYNOPSIS We examined the socio‐economic consequences of headache in a random sample of 514 working people living inthe Republic of San Marino. Our results show that, in the preceding year, 255 out of 514 (49.6%) suffered fromheadache; 31.9% (164/514) reported decreased efficiency as a consequence of headache; 9.3% (48/514) reportedthat head pain is always severe; 7.4% (38/514) were absent from work because of headache for a total of 338working days lost; 8.4% of all working days lost to illness were due to headache.We estimated that in the Republic of San Marino (21,792 inhabitants), headache causes a loss of at least 5,000working days every year. Since the cost of a working day in the Republic of San Marino is about 100,000 italianlire, the economic burden in this area amounts to 500 millions of lire in a year. This shows that headache is amajor socio‐medical problem.

Epidemiological studies on multiple sclerosis (MS) carried out in Southern Europe in the last years have shown a significant increase in the disease frequency. Previous surveys conducted in the Republic of San Marino, Northern Italian peninsula, identified that the population is at high risk for MS, with a prevalence of 51.6 per 100,000 population in 1982 and of 166.7 in 2005 and with a mean annual incidence of 7.9 per 100,000 for the period 1990-2005. The present work is a community-based intensive prevalence and incidence survey, by a complete enumeration approach, to update the prevalence and incidence of MS in the Republic of San Marino. The mean annual incidence for the period 2005-14 was 7.7 (95% CI 4.9-11.4) per 100,000, 3.3 (95% CI 1.1-7.6) for men and 11.9 (95% CI 7.2-18.6) for women. On 31 December 2014, 67 patients (19 men and 48 women), suffering from definite or probable MS and living in the Republic of San Marino, yielded a crude prevalence of 204.3 (95% CI 158.4-259.5) per 100,000, 117.8 (95% CI 70.9-183.7) for men and 288.2 (95% CI 212.4-383.3) for women. Our study has confirmed San Marino is an area at high risk for MS, in line with epidemiological data from continental Italy. The marked increase in MS prevalence over time in this population can be ascribable to increased survival and improved ascertainment, in the presence of a substantially stable, yet high, incidence rate.

References 1. Yamada K, Nonaka K: Diabetic ketoacidosis in young obese Japanese men: atypical diabetes induced by sugar-containing soft drinks (Letter). Diabetes Care 19:671, 1996 2. Tanaka K, Moriya T, Kanamori A, Yajima Y: Analysis and a long-term follow up of ketosis-onset Japanese NIDDM patients.