Francesca Chiaffarino

Reproductive factors, family history, occupation and risk of urogenital prolapse.

OBJECTIVE We conducted a case-control study to analyze risk factors for urogenital prolapse requiring surgery. METHODS Cases were 108 women with a diagnosis of II or III degree uterovaginal prolapse and/or third degree cystocele. Controls were 100 women admitted to the same hospitals as the cases, for acute, non-gynecological, non-neoplastic conditions. RESULTS Occupation showed an association with urogenital prolapse: in comparison with professional/managerial women, housewives had an odds ratios (OR) of urogenital prolapse of 3.1 (95% confidence interval (CI), 1.6-8.8). Compared with nulliparae, parous women tended to have a higher risk of genital prolapse (OR 2.6, 95% CI 0.9-7.8). In comparison with women reporting no vaginal delivery, the ORs were 3.0 for women reporting one vaginal delivery (95% CI 1.0-9.5), and 4.5 (95% CI 1.6-13.1) for women with two or more vaginal deliveries. Forceps delivery and birthweight were not associated with risk of prolapse after taking into account the effect of number of vaginal deliveries. The risk of urogenital prolapse was higher in women with mother or sisters reporting the condition: the ORs were, respectively, 3.2 (95% CI 1.1-7.6) and 2.4 (95% CI 1.0-5.6) in comparison with women whose mother or sisters reported no prolapse. CONCLUSIONS Our data support the clinical suggestion that parous women are at a higher risk of prolapse and the risk increases with number of vaginal deliveries. First-degree family history of prolapse seems to increase the risk of prolapse.

Impact of Urinary Incontinence and Overactive Bladder on Quality of Life

OBJECTIVE To assess the quality of life (QOL) of women with urinary incontinence (UI) or overactive bladder (OB) compared with women without UI. METHODS A case-control study conducted in Italy on risk factors for UI and OB. Information on QOL were collected using the SF-12 questionnaire, validated for Italian women. RESULTS A total of 1062 cases (258 had stress, 195 urge, 486 mixed UI and 123 OB without incontinence) and 1143 controls were interviewed. QOL, as assessed by the SF-12, was significantly impaired in cases compared with controls (p=0.0001); the mean SF-12 physical health score was 48.3 for controls, but 45.6, 42.0, 44.5 and 40.0 for cases with OB, urge, stress and mixed incontinence, respectively. Women with OB had significantly higher physical health scores than women with urge and mixed UI (p<0.005) (44.6 versus 41.7 and 41.3). Physical and mental health dimensions of cases significantly decreased with increasing severity of symptoms. CONCLUSIONS QOL was significantly impaired in women with UI or OB compared to controls. Physical and mental functioning tended to be more impaired in patients than in controls.

Diet and uterine myomas

OBJECTIVE To analyze the relation between selected dietary indicators and the risk of uterine myomas. METHODS We used data from a case-control study on risk factors for uterine myomas conducted in Italy between 1986 and 1997. Cases included 843 women with uterine myomas whose clinical diagnoses dated back no more than 2 years. Controls were 1557 women younger than age 55 who had not had hysterectomies and were admitted for acute nongynecologic, nonhormonal, nonneoplastic conditions. RESULTS Women with uterine myomas reported more frequent consumption of beef, other red meat, and ham and less frequent consumption of green vegetables, fruit, and fish. The multivariate odds ratios in the upper tertile were 1.7 for beef and other red meat (95% confidence interval [CI] 1.4, 2.2), 1.3 for ham (95% CI 1.0, 1.6), 0.5 for green vegetables (95% CI 0.4, 0.6), and 0.8 for fruit consumption (95% CI 0.6, 1.0). CONCLUSION Myoma is associated with beef and ham consumption, whereas high intake of green vegetables seems to have a protective effect.

Reproductive and hormonal factors and ovarian cancer

BACKGROUND Menstrual, reproductive and hormonal factors have been related to ovarian cancer risk, but further quantification of their role in various populations is required. PATIENTS AND METHODS Cases were 1031 women, below age 79, with incident, histologically confirmed epithelial ovarian cancer, and controls 2411 women, admitted between 1992 and 1999 to a network of hospitals in 4 Italian areas for acute, non-neoplastic, diseases. Odds ratios (OR) were obtained using multiple logistic regression. RESULTS Multiparity was associated with a significant reduction in risk of ovarian cancer (OR = 0.6 for 3, and 0.5 for > or = 4 births). No consistent association was observed with time since first or last birth, nor with spontaneous or induced abortions. Late age at menarche (OR = 0.8), and early menopause (OR = 0.6) were inversely related to risk, as did long-term oral contraceptive use (OR = 0.5, for > or = 5 years). Hormone replacement therapy in menopause was associated with a non-significantly elevated risk (OR = 1.4). The pattern of risk was similar for women with and for those without family history of breast or ovarian cancer. CONCLUSIONS This uniquely large study confirms and further quantities the relation between hormonal and reproductive factors and ovarian cancer. The pattern of risk observed cannot be totally explained by a role of ovulation in ovarian carcinogenesis.

Use of oral contraceptives and uterine fibroids: results from a case-control study

Objective To analyse the association between oral contraceptive use and the risk of uterine fibroids.

Risk factors for stress, urge or mixed urinary incontinence in Italy

Objective To assess risk factors for different type of urinary incontinence—stress, urge or mixed—and overactive bladder without urinary incontinence.

Diabetes and endometrial cancer: An Italian case-control study

We considered the association between diabetes and risk of endometrial cancer using data from a large case‐control study conducted in Italy. Cases were 752 women with incident, histologically confirmed endometrial cancer <75 years of age (median age 60 years, range 28–74) admitted to a network of hospitals in Milan. Controls were 2,606 patients (median age 54 years, range 25–74) aged <75 years, admitted for acute non‐neoplastic, non‐gynecological, non‐hormone‐related conditions to the same network of hospitals where cases had been identified. A total of 132 (17.6%) cases and 116 controls (4.5%) reported a history of diabetes. The corresponding multivariate odds ratio (OR) was 2.9 [95% confidence interval (CI) 2.2–3.9]. No association emerged with diabetes diagnosed under age 40 (likely to be insulin‐dependent diabetes), whereas the OR of endometrial cancer was 3.1 (95% CI 2.3–4.2) for diabetes diagnosed at age ≥40 years. The OR of endometrial cancer in women with history of diabetes was 3.0 for women with a body mass index (BMI) (QI) kg/m2 <25, 3.6 for those with a BMI of 25–29, and 3.3 for those with a BMI ≥30. No consistent interaction or modifying effect was observed for any other covariate. Our results confirm that non‐insulin‐dependent diabetes is associated with the risk of endometrial cancer. The association may be mediated through elevated oestrogen levels in diabetic women, hyperinsulinemia or insulin‐like growth factor‐I (IGF‐I).Int. J. Cancer 81:539–542, 1999.

Surgical site infections after elective neurosurgery: A survey of 1747 patients

OBJECTIVETo evaluate the incidence and risk factors of postsurgical site infections (SSIs) in elective neurosurgical procedures in patients treated with an ultrashort antibiotic protocol. METHODSIn this consecutive series of 1747 patients treated with elective neurosurgery and ultrashort prophylactic antibiotic therapy at the Fondazione Istituto Nazionale Neurologico “Carlo Besta” in Milan, the rate of SSIs was 0.7% (13 patients). When only clean neurosurgery was considered, there were 11 such SSIs (1.52%) in 726 craniotomies and one SSI (0.15) in 663 spinal operations. The antibiotic protocol was prolonged in every case of external communication as cerebrospinal fluid leaks or external drainages. RESULTSThe infection rate of the whole series was low (0.72%), and a risk factor identified for SSIs in clean neurosurgery was longer surgery duration. The relative risk estimate was 12.6 for surgeries lasting 2 hours and 24.3 for surgeries lasting 3 or more hours. Patients aged older than 50 years had a lower risk of developing SSI with a relative risk of 0.23 when compared with patients aged younger than 50 years. CONCLUSIONThe present series reports a low incidence of SSIs for elective neurosurgery, even for high-risk complex craniotomies performed for tumor removal. Given that an antibiotic protocol prolongation was used to pretreat any early signs of infection and external communication, the protocol was appropriate for the case mix. The two identified risk factors (surgical duration > 2 hours and middle-aged patients [16–50 yr]) may be indicators of other factors, such as the level of surgical complexity and poor neurological outcome.

Role of reproductive factors on the risk of endometrial cancer

We analyzed the role of reproductive factors on the risk of endometrial cancer using data from a case‐control study conducted in Italy. Cases were 752 women with histologically confirmed endometrial cancer <75 years of age. Controls were 2,606 patients <75 years of age admitted for acute, non‐gynecological non‐hormone‐related, non‐neoplastic conditions to the same network of hospitals where cases had been identified. In comparison with nulliparae, the risk of endometrial cancer tended to be lower in parous women, and the estimated multivariate odds ratios (ORs) were 0.9, 0.8 and 0.7, respectively, for women reporting 1, 2 and 3 or more births (χ12 trend 10.21). In comparison with women reporting no induced abortion, the ORs of endometrial cancer were 0.6 in women reporting 1 and 0.4 in those reporting 2 or more induced abortions. When considering parous women only, in comparison with women reporting their last birth 20 years before or longer, the ORs of endometrial cancer were 0.6 in those reporting their last birth 10–19 years before and 0.3 in those reporting their last birth <10 years before. Our results confirm and further quantify a protective role of pregnancy on the risk of endometrial cancer and provide insights on the time‐risk relationship between pregnancy and cancer of corpus uteri. Int. J. Cancer 76:784–786, 1998.© 1998 Wiley‐Liss, Inc.

Oral contraceptive use and benign gynecologic conditions. A review.

The following review considers the main epidemiologic data on oral contraceptives (OC) and the risk of major benign gynecologic diseases. Earlier studies investigating the relationship between OC use and functional ovarian cysts indicated that the use of high-dose combination OC have a protective effect, whereas low-dose monophasic or multiphasic pills have little or no effect. With regard to seromucinous cysts, the scanty data available are consistent with the notion of some protection of OC in current but not in former users, although possible effects of diagnostic and selection bias should be considered. Published data on the relationship between fibroids and OC appear too scattered to allow a precise quantification of risk. In any case, any relationship is moderate and, hence, of limited clinical and public health relevance. The data on OC and benign gynecologic conditions are reassuring in their absence of any consistent excess risk.