Alfredo Nicolosi

Epidemiology of erectile dysfunction in four countries: cross-national study of the prevalence and correlates of erectile dysfunction.

OBJECTIVESnTo measure the prevalence of erectile dysfunction (ED) in community-based populations in Brazil, Italy, Japan, and Malaysia and to study its association with the demographic characteristics, medical conditions, and health-related behavior.nnnMETHODSnIn each country, a random sample of approximately 600 men aged 40 to 70 years was interviewed using a standardized questionnaire. All the data were self-reported. ED was assessed by the participants ability to attain and maintain an erection satisfactory for sexual intercourse, and the men were classified as not having ED if they answered always and as having mild, moderate, or complete ED if they answered usually, sometimes, or never, respectively.nnnRESULTSnThe age-adjusted prevalence of moderate or complete ED was 34% in Japan, 22% in Malaysia, 17% in Italy, and 15% in Brazil. The overall age-specific prevalence of moderate or complete ED was 9% for men aged 40 to 44 years, 12% for 45 to 49 years, 18% for 50 to 54 years, 29% for 55 to 59 years, 38% for 60 to 64 years, and 54% for those 65 to 70 years. The increased risk of ED was associated with diabetes, heart disease, lower urinary tract symptoms, heavy smoking, and depression and increased by 10% per year of age. It was inversely associated with education, physical activity, and alcohol drinking.nnnCONCLUSIONSnED is an international problem, the prevalence and severity of which increases with age. Despite national variations in prevalence, uniform associations were found between ED and medical conditions and lifestyle habits.

The Efficiency of Male-to Female and Female-to-male Sexual Transmission of the Human Immunodeficiency Virus: A Study of 730 Stable Couples

To compare the efficiency of male-to-female and female-to-male sexual transmission of human immunodeficiency virus (HIV), we studied 524 female partners of HIV-infected men and 206 male partners of HIV-infected women in 16 Italian clinical centers. All of the partners had had a sexual relationship with the index case lasting for at least 6 months and presented no other risk factor than sexual exposure to the HIV-infected partner. Among the 730 couples, 24% of the female partners were HIV positive, in comparison with 10% of the male partners. Using logistic regression analysis, including gender and controlling for condom use, frequency of intercourse, anal sex, partners CD4+ cell count and clinical stage, sexually transmitted diseases, genital infections, and contraceptive use, we found that the efficiency of male-to-female transmission was 2.3 (95% confidence interval = 1.1–4.8) times greater than that of female-to-male transmission. Between-gender differences in the contact surfaces and the intensity of exposure to HIV during sexual intercourse are possible reasons for the difference in efficiency of transmission. (Epidemiology 1994;5:570–575)

Drug use in children: Cohort study in three European countries

Objective To provide an overview of drug use in children in three European countries. Design Retrospective cohort study, 2000-5. Setting Primary care research databases in the Netherlands (IPCI), United Kingdom (IMS-DA), and Italy (Pedianet). Participants 675u2009868 children aged up to 14 (Italy) or 18 (UK and Netherlands). Main outcome measure Prevalence of use per year calculated by drug class (anatomical and therapeutic). Prevalence of “recurrent/chronic” use (three or more prescriptions a year) and “non-recurrent” or “acute” use (less than three prescriptions a year) within each therapeutic class. Descriptions of the top five most commonly used drugs evaluated for off label status within each anatomical class. Results Three levels of drug use could be distinguished in the study population: high (>10/100 children per year), moderate (1-10/100 children per year), and low (<1/100 children per year). For all age categories, anti-infective, dermatological, and respiratory drugs were in the high use group, whereas cardiovascular and antineoplastic drugs were always in the low use group. Emollients, topical steroids, and asthma drugs had the highest prevalence of recurrent use, but relative use of low prevalence drugs was more often recurrent than acute. In the top five highest prevalence drugs topical inhaled and systemic steroids, oral contraceptives, and topical or systemic antifungal drugs were most commonly used off label. Conclusion This overview of outpatient paediatric prescription patterns in a large European population could provide information to prioritise paediatric therapeutic research needs.

Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors

To study the sexual activity and the prevalence of sexual dysfunctions and related help seeking behaviour, among people in Europe aged 40–80xa0years. A telephone survey was carried out in 2001–2002 in Sweden, the UK, Belgium, Germany, Austria, France, Spain and Italy, of 4,977 men and 5,023 women, using a structured, standardized questionnaire Eighty-three percent of men and 66% of women had sexual intercourse during the year preceding the interview. The sexual dysfunctions most frequently reported were early ejaculation (11%) and erectile dysfunction (8%) in men; and a lack of sexual interest (18%), an inability to reach orgasm (13%) and lubrication difficulties (11%) in women. Of the 23% of men and 32% of women who reported sexual dysfunction, 26% had consulted a physician, with considerable between-country differences. Sexual activity is widespread among adult middle-aged and elderly people, but many experience sexual dysfunctions and few seek medical care.

Medicines for children licensed by the European Medicines Agency (EMEA): the balance after 10 years

ObjectiveThe 1995–2005 balance of EMEA activities in the field of paediatric medicines was evaluated, taking into account the number both of drugs authorised for children and paediatric studies supporting the Marketing Authorisation (MA).MethodsData on drugs authorised by EMEA were extracted from EPARs (European Public Assessment Reports). Active substance, year of approval, anatomical, therapeutic and chemical (ATC) code, indication, orphan status, ages, and registrative clinical studies characteristics were assessed.ResultsThe percentage of authorised substances for paediatrics is 33.3%. This percentage decreased or increased when different subsets of medicines were considered [medicines for children under 2xa0years (23.4%), N-ATC code drugs (6%) and orphan drugs (46.4%)]. A total of 165 trials were included in the MA dossiers of 51 drugs at the time of approval, and additional 22 studies were added to the dossiers of 12 active substances submitted for paediatric variations. PK and Efficacy/Safety studies were performed for 32 (52%) active substances, while either one PK or one Efficacy/Safety study was carried out for 43 (69%) and 45 (73%) substances, respectively.ConclusionsThis report demonstrates that the total number of paediatric medicines approved by EMEA is stable over the 10-year period, while an increase in drugs to treat serious or orphan diseases has been observed. In addition, under the Centralised Procedure, a valuable number of paediatric trials have been submitted to support drug approval.

Dietary and nutritional patterns in an elderly rural population in Northern and Southern Italy: (I). A cluster analysis of food consumption

Objective: To describe the food consumption patterns of Italian elderly subjects and the factors associated with different dietary habits.Design: Cross-sectional study.Setting: Population-based study.Subjects: A total of 847 men and 1465 women aged 65u2009y or older, living in rural areas in the province of Pavia (Northern Italy) and near Cosenza (Southern Italy) in 1992–1993.Interventions: The dietary information was collected by means of a quantitative food-frequency questionnaire, with cluster analysis being used to segregate the subjects on the basis of similarities in their food consumption. A generalised logistic regression model including residence, age, living status, education, physical activity and degree of disability was fitted to assess the factors associated with different food consumption habits.Results: Six dietary clusters were selected for men and seven for women. The largest cluster for both genders was ‘small eaters’ (46% of men and 51% of women); ‘big eaters’, ‘light diet’ and ‘alcohol’ clusters were also identified for both genders. The men were also grouped into ‘balanced diet’ and ‘cheese’ clusters, and the women into ‘sweet’, ‘greens’ and ‘butter’ clusters.Conclusions: In addition to the influence of the area of residence — residents in Northern Italy consume greater amounts of animal fats, sugar and alcoholic beverages, and those living in Southern Italy have a greater intake of fruit, vegetables, fish and olive oil — all of the other studied variables predicted the probabilities of falling into a specific dietary cluster.Sponsorship: National Research Council (Italy) — ‘Invecchiamento’ Project No. 95.01048.PF40.

Dietary and nutritional patterns in an elderly rural population in Northern and Southern Italy: (II). Nutritional profiles associated with food behaviours

Objective: To describe the nutritional profiles of the food consumption patterns identified in an elderly Italian rural population.Design: Cross-sectional study.Setting: Population-based study.Subjects: A total of 847 men and 1465 women aged 65u2009y or older, resident in rural areas in the province of Pavia (Northern Italy) and near Cosenza (Southern Italy) in 1992–1993.Interventions: A cluster analysis segregated the subjects into six groups for men and seven for women on the basis of similarities in their food intake (see companion paper). The mean daily energy, macronutrient, mineral and vitamin intakes were calculated for the sample as a whole and for each cluster, and then compared with the age- and gender-specific recommended daily allowances for the Italian population.Results: The largest cluster (‘small eaters’, which included about half of the population) had an insufficient intake of essential fatty acids, calcium, potassium, zinc (men), iron (women), thiamin, riboflavin, niacin, β-carotene, and vitamins A, D and E. The most noticeable characteristics of some of the other clusters were a high intake of fats, a high proportion of total energy provided by sugars, a high intake of vitamin C, folic acid and β-carotene, and a high alcohol consumption. Furthermore, sodium intake was too high in all of the clusters and vitamin D intake was generally inadequate.Conclusions: The dietary habits of elderly Italians living in rural areas combine elements of the Mediterranean and ‘wealthy’ diets.Sponsorship: National Research Council (Italy) — ‘Invecchiamento’ Project no. 95.01048.PF40.

Trends in cataract surgery in Milan (Italy) from 1956 to 1987; Relationship to age and visual acuity

Abstract. In order to test whether the mean age at cataract surgery has changed over the course of the last 30 years, a hospital series of 5443 patients undergoing cataract extraction between 1956 and 1987 is reviewed. All cases attended the same University Eye Clinic of Milan and most were resident in the same geographical area. Cases with macular or optic nerve diseases were excluded. Results show that mean age at cataract surgery progressively increased from 67.5 to 71.5 years (slope = + 0.096 years of age per year, p = 0.0001) as did visual acuity at surgery (patients with visual acuity levels ≥1/10 at time of cataract surgery rose from 3.2% to 47.9%). These results can be interpreted in terms of a change in age composition of the Italian population, improved access to health services for the elderly, and an improvement in surgical and rehabilitation techniques.