Luca Tozzi

Cigarette smoking, alcohol consumption, and risk of primary dysmenorrhea.

We analyzed the relation between cigarette smoking, alcohol consumption, and risk of dysmenorrhea using data from a case-control study in Milan, Italy. With never-smokers as the reference category, the relative risk (RR) of dysmenorrhea was 1.9 [95% confidence interval (CI) = 0.9-4.4] for women smoking 10-30 cigarettes per day. The risk of dysmenorrhea increased with duration of smoking in women who smoked for less than 10 years (RR = 1.3, 95% CI = 0.6-2.6) and in those who smoked for 10-20 years (RR = 2.8, 95% CI = 1.3-6.2). In comparison with teetotalers, the age-adjusted RR of dysmenorrhea was 0.8 (95% CI = 0.4-1.5) for alcohol drinkers.

Moderate alcohol drinking and risk of preterm birth.

Objective: We have analysed the association between alcohol drinking before and during the three trimesters of pregnancy and risk of preterm birth of babies with normal weight for gestational age or with low weight for gestational age (SGA).Design: Case–control study.Setting: General and university hospitals in Italy.Subjects: Cases were 502 women who delivered preterm births <37 weeks gestation. The controls included 1966 women who gave birth at term (≥37 weeks of gestation) to healthy infants of normal weight (ie between 10th and 90th centile according to the Italian standard) on randomly selected days at the hospitals where cases had been identified.Interventions: Interview.Results: No increased risk of preterm birth was observed in women drinking one or two drinks/die in pregnancy, but three or more drinks/die increased the risk (multivariate odds ratios (OR) 2.0 for ≥3 drinks during the first trimester, 1.8 during the second and 1.9 during the third). When the analysis was conducted separately for preterm births with normal weight or SGA, the increased risk was observed in preterm SGA only (multivariate OR for ≥3 drinks/die during the first trimester=3.6, 95% confidence interval (CI) 1.3–11.1); the estimated multivariate OR for ≥3 drinks/die during the first trimester of preterm babies with normal weight for gestational age was only slightly above unity and not statistically significant (multivariate OR 1.4, 95% CI 0.5–3.7).Conclusions: The study shows an increased risk in mothers who drink ≥3 die units alcohol in pregnancy of preterm births.Sponsorship: Ministero della Ricerca Scientifica.

Contraceptive methods and risk of pelvic endometriosis

The relation between contraceptive methods and risk of pelvic endometriosis has been analyzed in a case-control study. Cases were 376 women with laparoscopically or laparotomically confirmed pelvic endometriosis admitted to a network of Obstetrics and Gynecology Clinics in Lombardy, Northern Italy. Controls were 522 women admitted for acute non-gynecological and non-obstetrics conditions to the same hospitals where cases had been identified. A total 153 women (40.3%) out of the 377 cases and 154 (29.7%) out of the 522 controls reported ever oral contraceptive (OC) use: the corresponding relative risk (RR) was 1.6 (95% confidence interval, CI, 1.2-2.2). The risk was restricted to ex-OC users (RR 1.7, 95% CI 1.3-2.4), the estimated RR for current users being 0.9 (95% CI 0.5-1.9). No clear relation emerged with duration, recency and latency of OC use and risk of endometriosis. In comparison with never IUD users, the risk for ever users was 1.3 (95% CI 0.6-2.8), and no clear relation emerged with duration of use. Likewise, no association was observed between barrier method of contraception and risk of endometriosis (RR ever vs never users 0.5, 95% CI 0.3-1.4). The role of selection and other biases should be considered in the interpretation of epidemiological data on the role of OC on the risk of endometriosis.

Lifelong Menstrual Pattern and Risk of Breast Cancer

The relationship between lifelong menstrual pattern and the risk of breast cancer has been analyzed using data from a large case-control study conducted since 1983 in the greater Milan area including 3,037 cases, aged 74 years or less, with histologically confirmed breast cancer and 2,569 control subjects admitted for acute nongynecological, nonneoplastic nonhormone-related conditions to the same network of hospitals where cases had been identified. Compared with women reporting lifelong regular cycles, those reporting irregularities were at significantly reduced risk of breast cancer, relative risk estimate being 0.6, with 95% confidence interval (CI) ranging from 0.5 to 0.8. This protection was restricted to women reporting totally irregular menstrual cycles; compared to women reporting menstrual cycles lasting 25 days or less, the estimated relative risks were 1.0 and 1.2 in those reporting cycles lasting 26-30 days or 31 days or more, respectively, but 0.6 (95% CI 0.5-0.8) for those reporting totally irregular cycles. The effect of irregular menstrual cycles was similar in different strata of age and main risk factors for breast cancer.

Risk Factors for Unexplained Dyspermia in Infertile Men: A Case-Control Study

This study was conducted to analyze risk factors for dyspermia in infertile subjects in a population of men attending outpatient services for infertility in Milan, Northern Italy. Between September 1989 and November 1990 we conducted a case-control study on risk factors for dyspermia. Cases included infertile men with a diagnosis of unexplained dyspermia consecutively observed for the first time during the study period at the Outpatient Service for Infertility of the First Obstetric and Gynecologic Clinic of the University of Milan. Specific work-up was done to exclude the major known or potential causes of dyspermia and infertility in patients and their partners. Two control groups were selected. The first included normospermic men of infertile couples with negative work-up for any disease that might affect fertility, observed in the same outpatient service where cases had been identified. The second control group included fertile men of unknown semen quality who were the partners of women who gave birth at term (> 37 w gestation) to health infants in randomly selected days at the same clinic. In comparison with those who have never smoked, current smokers were at increased risk of dyspermia versus both normospermic men of infertile couples and fertile men of unknown semen quality, and the risk increased with number of cigarettes smoked per day and duration of smoking. The risk of dyspermia increased with the number of cups of coffee drunk per day compared with men drinking no or one cup per day. Likewise, alcohol drinkers were at increased risk and the risk increased with number of drinks/d.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinants of risk of spontaneous abortions in the first trimester of pregnancy

Several factors, such as socioeconomic status, obstetrical and menstrual history, and contraceptive methods, have been associated with risk of spontaneous abortion. We conducted a hospital case‐control study to analyze risk factors for spontaneous abortion during the first trimester. Cases were 782 women admitted for spontaneous abortion. Controls included 1,543 women who gave birth at term in the same hospitals. Adjusted odds ratios (ORs) for spontaneous abortion were 0.9 and 0.6, respectively, for women reporting 7–11 and ≥12 years of schooling, compared with women reporting <7 years of education. A history of pelvic inflammatory disease increased the odds ratio fivefold [OR = 5.1; 95% confidence interval (CI) = 1.0–26.2]. The OR for spontaneous abortion was 1.7 (95% CI = 1.4–2.1) in women reporting previous spontaneous abortions.

Coffee drinking and risk of preterm birth.

Objectives:We analysed the association between coffee drinking before and during the three trimesters of pregnancy and the risk of preterm birth of babies normal for gestational age (NGA) or small for gestational age (SGA).Methods:Case–control study conducted in University clinics of North Italy. Cases were 502 women who delivered at <37 weeks of gestation. The controls included 1966 women who gave birth at term (⩾37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified.Results:There was inverse association for coffee consumption in the third trimester of pregnancy in SGA cases compared to NGA (heterogeneity test between OR: χ12=5.6811 P<0.05). In comparison with not drinkers, all the ORs of overall intake of caffeine were closed near the unity for both SGA and NGA preterm birth.Conclusion:Compared with no consumption, a low consumption of coffee during pregnancy may not have significant effects on preterm birth.

Dietary habits, reproductive and menstrual factors and risk of dysmenorrhoea

In order to analyze risk factors for dysmenorrhoea, we conducted a case-control study. Cases were 106 women (median age 27 years) with moderate or severe dysmenorrhoea lasting 12 months or more. Controls were 145 women (median age 26 years) without dysmenorrhoea, admitted for routine gynecological examination at the outpatient gynecological services of the same clinic where cases had been identified. In comparison with women reporting short menstrual cycles (every 25 days or less) the relative risk (RR) of dysmenorrhoea was 2.0 and 2.6, respectively, in those reporting their menstrual cycles of 26–30 days and of 31 days or more, and the RR was 3.6 (95% confidence interval (CI): 1.0– 13.4) for women reporting totally irregular menstrual cycles. The estimated RRs were, in comparison with women reporting menstrual flows lasting 4 days or less, respectively 2.2 and 1.9 in those reporting menstrual flows lasting 5 and 6 days or more. Fourty-four (58%) cases but only seven (5%) controls reported heavy menstrual flows (RR in comparison with women reporting slight or normal menstrual flow 12.6, 95% CI: 5.0–32.1). As regards dietary factors, no associations emerged between the various food items, with the exception of cheese and eggs, which tended to be more frequently consumed by cases than controls. The results of this study suggest that the risk of dysmenorrhoea is higher in women with irregular, long and heavy menstrual flows. No association emerged between reproductive history and dysmenorrhoea. Likewise, no clear relationship emerged between intake of several dietary factors and risk dysmenorrhoea.

Treatment with Tamoxifen and Progestins for Metastatic Breast Cancer in Postmenopausal Women: A Quantitative Review of Published Randomized Clinical Trials

The efficacy of tamoxifen (TAM) was compared to that of progestins (medroxyprogesterone acetate, MPA, and megestrol acetate, MA) in the treatment of metastatic breast cancer in postmenopausal women by a quantitative analysis of the results of published randomized clinical trials. Seven studies involving a total of 801 subjects compared TAM with MPA. Overall, the frequency of complete and partial response was 9 and 18%, respectively, in the women treated with TAM, versus 9 and 28% in those given MPA. Considering complete and partial responses together, the frequency of response was 29% in the TAM group and 39% in the MPA group, the corresponding pooled odds ratio (OR) of response being 1.5 (95% confidence interval, CI, 1.1-2.0). The median duration of response was greater in the TAM-treated patients; however, the difference was small (14 vs. 11 months). The probability of response to MPA treatment was about 3-fold higher compared with the response to TAM treatment in the subgroup with bone metastases (OR 3.4), and 2-fold higher in the subgroup with visceral metastases (OR 2.2), but the difference in the OR estimates was not statistically significant. The response to the two drugs was similar in the subgroup with metastases in soft tissues. Four studies compared TAM with MA, taking in 463 subjects. The overall frequency of complete and partial response was 35% in the patients who received TAM compared with 29% in those treated with MA. The corresponding pooled OR was 0.8 (95% CI 0.5-1.1). Analysis of the results according to site of metastases revealed no significant difference in the frequency of complete or partial response in the two treatment groups.

Trends in multiple births in Italy: 1955–1983

Summary. On the basis of the numbers of single and multiple births routinely collected by the Central Institute of Statistics, trends in multiple births in Italy over the period 1955–1983 were analyzed. Between 1955 and 1983 the frequency of multiple births declined by about 25% (from 12–6/1000 deliveries to 9‐6/1000 deliveries). The downward trend was constant until the early 1970s when rates tended to level off and increase slightly. This finding was largely attributable to trends in dizygotic rates, monozygotic births being approximately constant over the period considered. Multiple birth rates rose till age 35–39, being more than two times higher in this age group than in teenagers, but flattened off in the subsequent strata of age: this finding was constant over the period considered. Despite the general decreasing trend, the regional differences persisted largely unchanged, multiple birth rates being about 30% higher in Southern (and less developed areas) of the country than in the North of Italy. Geographic differences were limited to dizygotic pregnancies, monozygotic rates being constant (about 4/1000 pregnancies) in various areas.