75Archivio Italiano di Urologia e Andrologia 2017; 89, 1 ORIGINAL PAPER Urinary symptoms and sexual dysfunction among Italian men: The results of the #Controllati survey Vincenzo Mirone 1, Roberto Carone 2, Giuseppe Carrieri 3, Elisabetta Costantini 4, Giuseppe Morgia 5, Giuseppe Mario Ludovico 6, Donata Villari 7, Fabio Parazzini 8 on behalf of the #Controllati study group* 1 Università degli Studi di Napoli Federico II, UOC di Urologia della A.O.U. Federico II, Napoli, Italy; 2 Università degli Studi di Torino, Struttura Complessa di Neuro-Urologia A.O.U. Città della Salute e della Scienza, Torino, Italy; 3 Dipartimento Nefro/Urologico Clinica Urologica e Centro Trapianti di Rene, Università degli Studi di Foggia, Italy; 4 Sezione di Urologia Femminile, Funzionale e di Chirurgia Urologica Mini-invasiva. Dipartimento di Scienze Chirurgiche e Biomedicali, Università di Perugia, Italy; 5 Università degli Studi di Catania, Presidio Ospedaliero Policlinico, Catania, Italy; 6 Struttura Complessa Urologia, Ospedale “Miulli”, Acquaviva delle Fonti, Italy; 7 Università degli Studi di Firenze, SOD Chirurgia Urologica Mini-invasiva e dei Trapianti, Azienda Mista Universitaria Ospedaliera, Careggi, Italy; 8 Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, IRCCS Policlinico Milano, Italy. Objective: Prevention may improve the quality of life and sexual and reproductive health. To improve prevention require a comprehensive research approach that examines the frequency and risk fac- tors for urologic conditions. In June 2016 the Italian Urologic Society coordinated a preventive initiative : the 1st Week of Male Urologic Prevention ”#Controllati”. Material and methods: During the 1st Week of Male Urologic Prevention “#Controllati”, men aged 18 years or more were invited to attend participating urologic centers for a free of charge visit for counseling about urologic or andrologic con- ditions. Each participating man underwent a physical exami- nation. Further he was asked about his a medical history and about his urologic symptoms, sexual activity and possible related problems. Results: Data were collected in 81 centers: 2380 men answered the questionnaire. A total of 1226 subjects partici- pating in the study reported one or more urinary symptom [51.5% (IC 95% 48.9%-54.5%)]. The risk of any urinary symptoms increased with age: in comparison with men aged < = 30 years or less the risk of any urinary symptoms was 2.31, 2.92, 5.12, 7.82 and 17.02 respectively in the class age 31-40, 41-50, 51-60, 61-70 and > = 71. Overweight/obese men were at increased risk of any urinary symptoms [OR1.35 (95% CI 1.12-1.64)]. 27.2% (IC 95% overall 25.2% -29.3%) of the subjects had at least a sexual disorder (erec- tile dysfunction, premature ejaculation, hypoactive sexual desire). The erectile dysfunction and hypoactive sexual desire increased with age, but premature ejaculation tended to be higher among younger aged men aged 40 years or more. Current any urinary symptoms [OR 1.85 (CI 1.40-2.43)], hypertension [OR 1.66 (95% CI 1.21-2.26) and diabetes (OR 2.37 (95% CI 1.45-3.88)] increased the risk of erectile dysfunction. Conclusions: This large survey gives a picture of the burden of the more frequent urologic conditions offering useful infor- mation in order to focus preventive campaign. KEY WORDS: Risk factors; Urinary symptoms; Erectile dysfunc- tion; Premature ejaculation. Submitted 16 March 2017; Accepted 21 March 2017 Summary No conflict of interest declared. DOI: 10.4081/aiua.2017.1.75 INTRODUCTION Urologic diseases are common among men, leading to significant economic, quality of life and public health issues (1). For example, the reported prevalence of lower urinary tract symptoms (LUTS) is about 50% (2) and of erectile dysfunction 12% (3). Among Italian men, the lifelong risk of urologic cancer (prostatic bladder and kidney cancer) is about one out of ten (4). The burden of urologic diseases in men will increase as the population ages, and risk factors for LUTS, including diabetes and obesity, remain highly prevalent (5). Adequate prevention, especially in the field of urology, made in young, adult and advanced age, significantly reduces the frequency of cancer (prostate, kidney, bladder and testicle), allowing also an early diag- nosis and timely treatment, and benign disease (urolithi- asis, benign prostate hyperplasia and prostatitis, male infertility and sexual dysfunction), that can determine, if neglected, a reduction in the quality of life, and sexual and reproductive health damage. Otherwise, to improve prevention requires a compre- hensive research approach that examines the frequency and risk factors for urologic conditions. In June 2016 the Italian Urologic Society (SIU) coordinat- ed a huge preventive initiative: the 1st Week of Male Urologic Prevention “#Controllati”. In this paper, we pres- ent the results of the initiative, with a special focus on LUTS and sexual dysfunction. METHODS During the 1st Week of Male Urologic Prevention “#Control - lati” (June 2016), men aged 18 years or more were invited to attend participating urologic centers for a free of charge visit for counselling about urologic or andrologic condi- tions. A pamphlet inviting men for a free of charge check-up and listing participating centers was left in chemists and general practitioners’ waiting rooms and Parazzini_Stesura Seveso 04/04/17 09:29 Pagina 75 Archivio Italiano di Urologia e Andrologia 2017; 89, 1 V. Mirone, R. Carone, G. Carrieri, E. Costantini, G. Morgia, G.M. Ludovico, D. Villari, F. Parazzini on behalf of the #Controllati study group 76 included in two weekly national journals; an advertising campaign was set in the press and broadcast media. Each participating man underwent a physical examina- tion. Further he was asked about his a medical history and about his urologic symptoms, sexual activity and possible related problems. Data were recorded with a simple questionnaire used by all centers. The first section, about age, marital, educational and pro- fessional status, weight, height, family history of prostatic cancer was completed by the patient. History of hyperten- sion, diabetes and other medical conditions, and the find- ings of the clinical examination, were recorded by the physician. Erectile function was assessed by asking men about their sexual performance: erectile dysfunction (ED) was diagnosed according to the definition of the NIH Consensus Development Panel (6), when a man was consis- tently unable to attain or maintain a penile erection suffi- cient for satisfactory sexual performance. A man was diagnosed as suffering from premature ejac- ulation (PE) if he had “persistent or recurrent ejaculation with minima sexual stimulation before, or shortly after pene- tration, and before the person wishes” according to the cat- egorization of the American Psychiatric Association. Patients were directly asked about the presence of this disorder during the visit. The 2002 ICS definitions were used for frequency, noc- turia, urgency, dysuria (intermittency, slow stream, straining, terminal dribble, postmicturition dribble) incomplete emptying (7). A total of 181 centres partici- pate to the initiative, 70 in the North, 45 in the center and 66 in the South of Italy. However, epidemiological data were collected in 81 centers for a total of 2380 men who filled the questionnaire [mean number for center 29 (SD 21), median 25 (interquartile range 24-40)]. Mean (standard deviation, SD), median (range) or fre- quency (percent, %) were computed as appropriate. Were also calculated where appropriate confidence lim- its at 95% of the proportions. Finally, we ran an analysis on the risk factors for sexual dysfunction (separately for ED and PE) and urinary disor- ders. Odds ratios (OR), and the corresponding 95% confi- dence intervals (CI), were derived using unconditional multiple logistic regression, fitted by the method of maxi- mum likelihood, in which the dependent variable was the presence (case) or absence (control) of the condition and the independent ones were the exposures considered in the analysis. We included in the model potential co-variates considered as categorical variables (8). The terms included in the model are indicated in the footnotes of the Tables. RESULTS The general characteristics of study subjects are shown in Table 1: the mean age was 53.6 years (DS 11.5, median age 53 years, range 18-87). The most frequent class age was 41 to 50 years (31.09%). The mean body mass index (BMI) was 26.0 (DS 3.6) and the median 25.5. Most participants were ever married (70.1%). The 13.2% of subjects reported a diagnosis of hyperten- sion and 3.7% of diabetes. A family history of prostatic cancer was reported in 9.8% of subjects. Frequency of PSA test screening and semen analysis A total of 1291 men (54.2%, 95% CI 51.3% -57.3%) of the study subjects reported PSA testing. Considering subjects aged 70 years or more, this percentage increased to 84.9% (95% CI 71.9% -99.5%). Overall, 325 men reported a least one semen analysis in life (13.7%, 95% CI 12.2-15.1%) (Table 2). Frequency of and risk factors for urinary symptoms A total of 1226 subjects participating in the study report- ed one or more urinary symptom (51.5%, CI 95% 48.9%-54.5%). The most commonly reported urinary symptom was nocturia, in age groups 50 or more, whereas in younger age groups frequency was the most reported (Table 3). Table 1. Characteristics of study subjects. N % Age (years) ≤ 30 60 2.6 31-40 171 7.5 41-50 740 32,3 51-60 679 29.7 61-70 467 20.4 ≥ 71 172 7.5 Marital status Never married 497 22.6 Married 1668 75.8 Divorced/widower 36 1.6 BMI (kg/m2) < 25.0 877 44.1 25.0 -29.9 886 44.6 ≥ 30.0 225 11.3 Hystory of Hyperthension (yes) 314 13.2 Diabetes (yes) 87 3.7 Family history of prostatic cancer (yes) 232 9.8 Sometimes, the sums do not add up the total due to missing values Table 2. Subjects reporting one or more PSA testing and semen analysis in life in strata of age. > = 1 PSA test in life > = 1 semen analysis in life No* Yes No Yes N % N % N % N % Age (years) ≤ 30 58 2 52 8 (No. = 60) 96.7 3.3 86.7 13.3 31-40 158 13 138 33 (No. = 171) 92.4 7.6 80.7 19.3 41-50 508 232 605 135 (No. = 740) 68.7 31.4 81.8 18.2 51-60 211 468 580 99 (No. = 679) 31.1 68.9 85.4 14.6 61-70 84 383 433 34 (No. = 467) 18.0 82.0 92.7 7.3 ≥ 71 26 146 164 8 (No. = 172) 15.1 84.9 95.4 4.7 Total 1089 1291 2055 325 No. = 2380 45.8 54.2 86.3 13.7 *Sometimes, the sums do not add up the total due to missing values. Parazzini_Stesura Seveso 04/04/17 09:29 Pagina 76 We analyzed risk factors for any urinary disorders: the results of the analysis are presented in Table 4. The risk of any urinary symptoms increased with age: in compar- ison with men aged < = 30 years or less the risk of any urinary symptoms was 2.31, 2.92, 5.12, 7.82 and 17.02 respectively in the age classes 31-40, 41-50, 51-60, 61- 70 and > = 71. Overweight/obese men were at increased risk of any uri- nary symptoms (OR 1.35, 95% CI 1.12-1.64). Further, any current sexual dysfunction was associated with an increased risk of any urinary symptoms (OR1.60. 95% CI 1.29-1.98). Analyzing the association of overweight/obesity and any current sexual dysfunction separately for the various uri- nary symptoms, we observed similar results. Frequency and risk factors of sexual dysfunction Table 5 shows the distribution of study subjects in stra- ta of age according to the presence of sexual dysfunction (erectile dysfunction, premature ejaculation, hypoactive sexual desire). 27.2% (IC 95% overall 25.2% -29.3%) of the subjects had at least a sexual disorder. The rate was 30.0% (CI 95% 18.3% -46.5%) in 30 or less, then slightly decrease in group 31-50 and increased in older age groups, being 41,9% in the men aged > = 71 years. The erectile dysfunction and hypoactive sexual desire increased with age, but premature ejaculation tended to be higher among younger aged men aged 40 years or more. 11.9%, (44, % 95% CI 8.7% -15.8%) of men reporting erectile dysfunction were currently treated for the condi- tion (data not shown in Table). We computed risk factors for sexual dysfunction sepa- rately for premature ejaculation and erectile dysfunction. The results of the analysis are presented in Table 6. The OR of premature ejaculation decreased with age being, in comparison with men aged < = 30 years, 0.16 (95% CI 0.05-0.50) in men aged > 70 years. 77Archivio Italiano di Urologia e Andrologia 2017; 89, 1 Urinary and sexual disease in Italy Table 3. Frequency of urinary symptoms according to age. Nocturia Dysuria Incomplete Urgency Frequency Any emptying symptom N % N % N % N % N % N % Age (years) ≤ 30 1 4 1 3 3 9 (No. = 60) 1.7 6.7 1.7 5.0 5.0 15.0 31-40 16 20 13 12 25 53 (No. = 171) 9.4 11.7 7.6 7.0 14.6 31.0 41-50 101 88 85 78 90 282 (No. = 740) 13.7 11.9 11.5 10.5 12.2 38.1 51-60 174 116 139 111 125 378 (No. = 679) 25.6 17.1 20.5 16.4 18.4 55.7 61-70 189 81 119 94 104 317 (No. = 467) 40.5 17.3 25.5 20.1 22.3 67.9 ≥ 71 89 46 59 47 51 141 (No. = 172) 51.7 26.7 34.3 27.3 29.7 82.0 Total 587 375 428 350 409 1226 No. = 2380 24.7 15.8 18.1 14.7 17.2 51.5 Sometimes, the sums do not add up the total due to missing values. Table 4. Odds ratios (and corresponding 95% confidence intervals) of any urinary symptom according to selected factors. Any urinary symptoms No Yes OR (95CI%) N* % N % Age (years) ≤ 30 51 9 85.0 15.0 1° 31-40 118 53 69.0 31.0 2.31 (1.03-5.19) 41-50 458 282 61.9 38.1 2.92 (1.39-6.11) 51-60 301 378 44.3 55.7 5.12 (2.44-10.75) 61-70 150 317 32.1 67.9 7.82 (3.68-16.74) ≥ 71 31 141 18.0 82.0 17.02 (7.36-39.33) BMI (kg/m2) < 25.0 491 386 56.0 44.0 1° ≥ 25.0 475 636 42.8 57.3 1.35 (1.12-1.64) Marital status Never married 306 191 61.6 38.4 1° Married 741 927 44.4 55.6 1.12 (0.8-1.44) Divorced/vidower 17 19 47.2 52.8 0.80 (0.34-1.89) Any sexual dysfuncion No 916 817 52.9 47.1 1° Yes 238 409 36.8 63.2 1.60 (1.29-1.98) *Sometimes, the sums do not add up the total due to missing values °Reference category OR: odds ratio; CI: confidence interval. Multivariate estimates including terms for the above listed variables. Table 5. Frequency of sexual dysfunction according to age. Erectile Premature Hypoactive Any sexual dysfunction ejaculation sexual desire dysfunction N % N % N % N % Age (years) < =30 6 10 2 18 10.0 16.7 3.3 30.0 31-40 15 20 7 30 8.8 11.79 4.1 22.8 41-50 52 55 39 127 7.0 7.4 5.3 17.2 51-60 107 46 61 184 15.8 6.8 9.0 27.1 61-70 122 35 49 181 26.1 7.5 10.5 38.8 > = 71 51 6 19 72 29.7 3.5 11.2 41.9 Total 370 178 182 647 15.6 7.5 7.7 27.2 Sometimes, the sums do not add up the total due to missing values. Parazzini_Stesura Seveso 04/04/17 09:29 Pagina 77 Archivio Italiano di Urologia e Andrologia 2017; 89, 1 V. Mirone, R. Carone, G. Carrieri, E. Costantini, G. Morgia, G.M. Ludovico, D. Villari, F. Parazzini on behalf of the #Controllati study group 78 2.43)], hypertension [OR 1.66 (95%CI 1,21-2,26)] and diabetes [OR 2.37 (95%CI 1.45-3.88)] increased the risk of erectile dys- function. DISCUSSION Before discussing the results of this survey, potential limitations should be considered. The major flaw of this study is that the study population were men vol- untarily presenting to the participating centers and physicians associated to the Italian Society of Urology (SIU). The participating centers were not randomly identified among all members, so they cannot be consid- ered representative of all Italian centers. However, they were well distributed over the main areas of the country and there were no marked differences in the results among centers in various large Italian areas, giving strong support to the consistency of the general results. Further, the prevalence of hypertension and diabetes and overweight were largely similar to the general Italian population. For example the percentage of over- weight and obese men was largely similar to that of the Italian popula- tion (9). Finally, the participation rate was very high: for example the answers to the questions about sexuality were missing in a few number of men. Along this line, the patients presented voluntarily to the physi- cian, so their answers to sensitive questions about sexual dysfunction should be truthful. The strengths of the study included the fact that it provides information from a large series of men identified in all parts of Italy. Despite the limitations, the results of this large survey gives a general picture of the burden of urological conditions in the Italian popula- tions. Urinary symptoms First of all In the present study the self reported frequency of most common low urinary tract symptoms (LUTS) was about 50%, a proportion largely similar to that reported in the Italian centers of EPIC study. In that study nocturia was the most prevalent LUTS (2). Table 6. Odds ratios (and corresponding 95% confidence intervals) of premature ejaculation and erectile dysfunction according to selected factors. Premature ejaculation Erectile dysfunction No Yes OR (95%CI) No Yes OR (95%CI) N* % N % N % N % Age (years) <=30 50 10 54 6 83.3 16.7 1° 90.0 10.0 1° 31-40 151 20 156 15 88.3 11.7 0.42 (0.16-1.08) 91.2 8.8 1.07 (0.33-3.52) 41-50 685 55 688 52 92.6 7.4 0.40 (0.18-0.88) 93.0 7.0 0.80 (0.28- 2.34) 51-60 633 46 572 107 93.2 6.8 0.34 (0.15-0.76) 84.2 15.8 1.62 (0.56-4.67) 61-70 432 35 345 122 92.5 7.5 0.38 (01.7-0.89) 73.9 26.1 2.56 (0.88-7.42) > = 71 166 6 121 51 96.5 3.5 0.16 (0.05-0.50) 70.4 29.7 3.31 (1.10-9.95) BMI (kg/m2) > = 24.9 806 71 767 110 91.9 8.1 1° 87.5 12.5 1° > = 25.0 1027 84 895 216 92.4 7.6 0.96 (0.68-1.95) 80.6 19.4 1.25 (0.96-1.63) Marital status Never married 455 42 443 54 91.6 8.5 1° 89.1 10.9 1° Married 1541 127 1377 291 92.4 7.6 1.30 (0.82-1.07) 82.6 17.5 0.84 (0.58-1.21) Divorced/vidower 32 4 n.d. 26 10 100.0 0.0 76.0 24.0 1.71 (0.62-4.77) Urinary symtoms No 1069 85 1041 113 92.6 7.4 1° 90.2 9.8 1° Yes 1133 93 969 257 92.4 7.6 1.32 (0.93-1.89) 79.0 21.0 1.85 (1.40-2.43) Erectile dysfunction No 1863 147 92.7 7.3 1° - - - Yes 339 31 91.6 8.4 1.42 (0.92-2.21) - - - Premature ejaculation No - - - 1863 339 84.6 15.4 1° Yes - - - 203 279 42.1 58.0 1.45 (0.94-2.23) Hypertension No 1909 157 1793 273 92.4 7.6 1° 86.8 13.2 1° Yes 293 21 217 97 93.3 6.7 0.88 (0.53-1.49) 69.1 30.9 1.66 (1.21-2.26) Diabetes No 2119 174 1960 333 92.4 7.6 1° 85.5 14.5 1° Yes 83 4 50 37 95.4 4.6 0.57 (0.20-1.62) 57.5 42.5 2.37 (1.45-3.88) *Sometimes, the sums do not add up the total due to missing values °Reference category OR: odds ratio; CI: confidence interval. Multivariate estimates including term for the above listed variables. Nd. Not determined. The OR of erectile dysfunction increased with age being, in comparison with men aged < = 30 years, 3.31 (95% CI1, 10-9.95) in men aged > 70 years. Current any urinary symptoms [OR 1.85 (CI 1.40- Parazzini_Stesura Seveso 04/04/17 09:29 Pagina 78 We confirm these findings. The frequency of urinary symptoms increased markedly with age being about 15% among men aged 30 years or less, but 82% among those aged 71 or more. This findings is consistent with other epidemiologic studies of LUTS conducted in men, which also showed that the prevalence of all symptoms increased linearly with age (10, 11). Overweight/obesity increased the risk of urinary symp- toms. In particular overweight /obesity increased the risk of urgency. This finding is consistent with data from other populations (12). Interestingly concurrent sexual dysfunction increased the risk of urinary symptoms. Sexual dysfunction This study also give further data on the frequency of the main sexual dysfunctions in the Italian populations. In the present survey the reported frequency of prema- ture ejaculation was lower than previously reported among Italian men. For example, the prevalence of premature ejaculation was of about 20% in a large survey of men attending a free andrologic consultation in about 200 Italian medical centers, in the 2001 (13). This difference may be partly due to the fact that in the 2001 survey the mean age of participants was lower than in the present study. It has been suggested that diabetes decreased the risk of PE. For example a decreased risk of PE was found in men with treated diabetes (OR 0.6, 95% CI 0.5-0.8) in men attending a free andrologic consultation in 186 Italian medical centers, in the setting of a project focused on andrologic prevention in Italy (13). It is well known that diabetic patients may develop failure of emission, due both to neuropathic changes of the sympathetic fibers innervating the bladder neck and to aperistalsis of the vas deferens (14). These changes act in opposition to the mechanism of PE, so that it seems diabetes gives a protective effect against such condition In our study the estimated OR od EP was lower than unity in men reporting diabetes, but the finding was not statistically significant, possibly due to the limited number of diabetics. With regard to erectile dysfunction, the present analysis confirm that ED is a common condition, particularly among older men. The estimated prevalence of the con- ditions reported in this study is largely consistent with the findings of a population based study conducted in Italy in the late ’90 showing a prevalence of ED of about 12% 3. Further this study confirms that diabetes, and hyperthension increased the risk of erectile dysfunction. A more interesting findings id the opportunity of analyz- ing in a large data set the association between urinary symptoms and ED. Some recent data have in fact linked ED risk with the presence of LUTS (15). We recorded if men suffered from several urinary symptoms: an associ- ation emerged between these symptoms and ED. Finally, another interesting finding emerging from this survey is the fact that about 85% of subjects aged > 70 year reported on or more PSA test life. This proportion however lowered to less than 70% among men aged 51- 60 year. This finding is consistent with that reported in other countries. For example about 60% of US men aged 76 or older with no history of prostate cancer reported having had a PSA test in year before the inter- view (16). Otherwise semen analysis is uncommonly reported: less than 15% of men reported one or more semen analysis in life. 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Villari, F. Parazzini on behalf of the #Controllati study group 80 erectile dysfunction, and their correlation in men aged 50 years and above: a cross-sectional survey in Beijing, China. Med Sci Monit. 2014; 20:2806-10. 16. Li J, Zhao G, Pollack LA, et al. Use of the prostate-specific anti- gen test among men aged 75 years or older in the United States: 2006 Behavioral Risk Factor Surveillance System. Prev Chronic Dis. 2010; 7(4). Available at : https://www.cdc.gov/pcd/issues//2010/jul/ pdf/09_0167.pdf. (Last access 15 March 2017). 2010. Correspondence Vincenzo Mirone, MD Università degli Studi di Napoli Federico II, UOC di Urologia della A.O.U. Federico II, Napoli, Italy Roberto Carone, MD Università degli Studi di Torino, Struttura Complessa di Neuro-Urologia A.O.U. Città della Salute e della Scienza, Torino, Italy Giuseppe Carrieri, MD Dipartimento Nefro/Urologico Clinica Urologica e Centro Trapianti di Rene, Università degli Studi di Foggia, Foggia, Italy Elisabetta Costantini, MD Sezione di Urologia Femminile, Funzionale e di Chirurgia Urologica Mini-invasiva. Dipartimento di scienze chirurgiche e biomedicali Università di Perugia, Perugia, Italy Giuseppe Morgia, MD Università degli Studi di Catania Presidio Ospedaliero Policlinico Catania, Italy Giuseppe Mario Ludovico, MD Struttura Complessa Urologia Ospedale “Miulli”, Acquaviva delle Fonti, Italy Donata Villari, MD Università degli Studi di Firenze, SOD Chirurgia Urologica Mini-invasiva e dei Trapianti Azienda Mista Universitaria Ospedaliera Careggi Firenze, Italy Fabio Parazzini, MD (Corresponding Author) fabio.parazzini@unimi.it Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Via Commenda 12, 20122 Milano, Italy *PARTICIPATING CENTRES: Abbate F (Caltagirone), Altomare M (Molfetta), Amici A (Roma), Anceschi C (Roma), Arena G (Cuneo), Artibani W (Verona), Avolio A (Ascoli Piceno), Bassi P (Roma), Battaglia M (Bari), Beatrici V (Pesaro-Fano), Beleggia F (Taranto), Bianchi G (Modena), Boccafoschi C (Alessandria), Bocciardi AM (Milano), Brausi M (Carpi), Brigante S (Brindisi), Bruschetta S (Messina), Buizza C (Busto Arsizio), Cafarelli A (Ancona), Caggiano S (Caserta), Canclini LP (Milano), Cappa M (Roma), Caraceni E (Civitanova Marche), Caravetta A (Acri), Carbone A (Latina), Carini M (Firenze), Carluccio G (Tricase), Catanzaro F (Cesano Boscone), Cavaliere A (Lecce), Cavalieri S (Negrar), Cecchi M (Lido Di Camaiore), Celia A (Bassano del Grappa), Chincoli S (Andria), Cicalese V (Avellino), Cisternino A (S. Giovanni Rotondo), Conti E (Sarzana), Corrada PL (Vizzolo Predabissi), Cosentino V (Catania), Cossu FM (Nuoro), Cusumano R (Roma), Cuzzocrea DE (Bologna), Dal Bianco M (Padova), Damiano R (Catanzaro), d’Anca M (Enna), D’Andrea R (Canistro), De Antoni (Udine), De Ceglie G (Cerignola), De Lisa A(Cagliari), Del Boca C (Cremona), De Martin M (Reggio di Calabria), De Siati M (Altamura), De Sio M (Napoli), De Zorzi L (Castelfranco Veneto), Defidio L (Roma), Di Clemente L (Coppito), Di Clemente L (Avezzano), Di Marco M (Roma), Di Martino M (Avellino), Di Stefano G (Ottaviano), Ditonno P (Bari), Di Trapani D (Palermo), Emili E (Imola), Fasolis G (Alba), Ferrando U (Torino), Ferrara V (Jesi), Ferrari G (Modena), Ficarra V (Udine), Fiorentino V (Lagonegro), Fischetti G (Roma), Frea B (Torino), Galli R (Bergamo), Galosi AB (Ancona), Gambarella Cherubino M (Mercogliano), Frattini A (Guastalla), Garbeglio A (Pordenone), Gentile V (Roma), Giulianelli R (Roma), Gontero P (Torino), Greco F (Roca di Neto), Greco U (Salerno), Gregori A (Garbagnate Milanese), Grisanti R (Sassuolo), Grosso G (Peschiera del Garda), Guizzardi F (Caltanisetta), Imperatore V (Napoli), Italiano E (Palermo), Ippolito C (Cona), Jungano R (Napoli), La Rocca L (Martina Franca), Laganà A (Tivoli), Leonardi R (Gravina di Catania), Lotesoriere O (Copertino), Lovisolo JA (Saronno), Lusuardi L (Bolzano), Maccatrozzo L (Treviso), Madonia M (Sassari), Maestroni UV (Parma), Magno C (Messina), Malossini G (Trento), Mammana G (Macerata), Manoni L (Pistoia), Marascia G (Chieti), Marchionni L (Roma), Martorana G (Bologna), Mastroeni F (Messina), Mearini E (Terni), Meneghini A (Santorso), Mensi M (Voghera), Merciai M (Oliveto Citra), Merlo F (Venezia Mestre), Minervini MS (Sondrio), Monesi G (Borgosesia) Montorsi F (Milano), Morelli E (Mirabella Eclano), Natali A (Firenze), Nigro GL (Crotone), Oliva G (Montepulciano), Paola Q (Sciacca), Pecoraro G (Isola Della Scala), Pennisi M (Catania), Perdonà S (Napoli), Pescione E (Napoli), Pompa P (Pescara), Ponchietti R (Siena), Porena M (Perugia), Porpiglia F (Orbassano), Porreca A (Abano Terme), Zito AR (Napoli), Raber M (Milano), Ranieri A (Lovere), Ranno S (Catania), Ricapito VD (Monopoli), Risi O (Treviglio), Rizzotto A (Viterbo), Rosa A (Verbano-Cusio-Ossola), Ruggiero G (Telese Terme), Russo G (S. Giorgio a Cremano), Saita A (Catania), Salvia G (Catania), Salzano L (Benevento), Sandri S (Magenta), Sanseverino R (Nocera Inferiore), Schiavone D (Rovigo), Scoffone C (Torino), Scognamiglio G (Castellamare Di Stabia), Schips L (Chieti), Selli C (Pisa), Sepe G (Mondragone), Simeone C (Brescia), Simonato A (Palermo), Sorrentino M (S. Maria Caupa Vetere), Striano S (Caserta) Tasso M (Brà), Tasso M (Tivoli), Tenaglia R (Chieti), Terrone C (Genova), Traficante A (Carbonara di Bari), Tralce L (Chiari), Trombetta C (Trieste), Tubaro A (Roma), Tufano A (Eboli), Tura M (Monza), Ventura F (Cosenza), Verbena A (Locri), Vespasiani G (Roma), Vicentini C (Teramo), Vita A (Potenza), Voce S (Ravenna), Volpe A (Novara), Xausa D (Feltre), Zarrelli G (Vercelli), Zaramella S (Ponderano), Zago T (Rho), Zattoni F (Padova), Zoccali C (Lamezia Terme). Data analysis: Ricci E, Esposito G (Milano). Parazzini_Stesura Seveso 04/04/17 09:29 Pagina 80