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Biomedical subjects

F Parazzini

Publications and source records attributed to F Parazzini.

At least 73 records · Page 4Linked to original sources
PubMed2000

The cost of urinary incontinence in Italian women. A cross-sectional study. Gruppo di Studio Incontinenza.

OBJECTIVE: To offer cost estimates of urinary incontinence (UI) in the general population based on prospectively collected data. DESIGN: We analyzed individual costs in a sample of women with UI who were identified in the framework of a cross-sectional study on the prevalence of UI in women aged > 40 years. SETTING: Six areas in Italy. INTERVENTION: Home interview. PATIENTS AND PARTICIPANTS: Women were identified among the patients registered with a network of general practitioners operating in each area using computer-generated random number lists. RESULTS: A total of 2767 women were identified. Of these, 408 (14.7%) reported UI during the year before the interview and 229 underwent a detailed interview on UI-related costs. On the basis of this information, we estimated the direct costs associated with UI from the perspective of the Italian National Health Service (INHS). The lifetime cost per patient of diagnosis was 80,131 Italian lire (L) (exchange rate: $US1 = L1618). Consultations accounted for only 20% of the diagnostic cost, diagnostic tests for 36% and hospital admissions for diagnostic procedures accounted for 44%. The diagnosis cost estimate seems low, partly because several women did not request either consultations or diagnostic tests (the overall rate per patient was 0.76 for consultations and 0.39 for diagnostic tests). The only appreciable treatment cost, according to the INHS perspective, was for diapers. The annual cost per patient for diapers was L255,519. The prevalence of UI in women aged > 40 years in Italy is estimated in the study at 9.3%. Thus, combining this information with the cost estimates, the annual treatment cost of UI in Italian women aged > 40 years is L351,800 billion, considering diapers and drugs only. CONCLUSION: This study has estimated the individual cost of UI in the general population. These figures may be useful when designing economic evaluations of UI.

Adult↗
PubMed2000

Cross-sectional study of determinants of menopausal age and hormone replacement therapy use in Italian women.

OBJECTIVE: The aim of the study was to analyze determinants of age at menopause and hormone replacement therapy (HRT) use. Women included were identified in a large cross-sectional study into epidemiology of the menopause among a sample of women visiting their general practitioners, conducted in Italy. METHODS: Eligible women were identified among consecutive patients, aged 44-66 years, who visited their general practitioner for a general health check-up during the period May-November 1997. A total of 16,916 postmenopausal women were identified by 1123 general practitioners. RESULTS: Overall, the mean age at menopause was 50.2 (SD 3.8) years. Ever-married women reported a slightly higher age at spontaneous menopause than that of never-married women. The finding was significant, but the difference was small. Smoking women reported a younger age at menopause. No clear association emerged between age at menopause, physical activity and body mass index (BMI). A total of 3515 women (20.8%) reported HRT ever-use; the mean duration of use was 3.6 years. HRT use was more frequent among women of higher socioeconomic status, those with a lower BMI and smokers. In particular, in comparison with women reporting a BMI of < 25 kg/m2, the odds ratio (OR) of HRT use was 0.7 (95% confidence interval (CI) 0.7-0.8) and 0.5 (95% CI 0.4-0.6), respectively, in women with a BMI of 25-28 kg/m2 and > or = 29 kg/m2. No association emerged between alcohol consumption, level of physical activity and HRT use. Diabetic women reported HRT use less frequently than non-diabetic women. Likewise, hypertensive women, and those with a history of cardiovascular disease, were less likely to be HRT users than those not reporting these conditions. Women with a diagnosis of osteoporosis/osteopenia reported HRT use more frequently. CONCLUSION: This study, using a large dataset from an Italian population, has confirmed that smoking is related to age at menopause. It has also demonstrated that HRT is more frequently used by women of higher socioeconomic status, those with low BMI and smokers. Diabetes is associated with less frequent use of HRT; conversely, osteoporosis/osteopenia is associated with more frequent HRT use.

Adult↗
PubMed2000

Erectile dysfunction in type 1 and type 2 diabetics in Italy. On behalf of Gruppo Italiano Studio Deficit Erettile nei Diabetici.

BACKGROUND: Several studies reported data on the increased risk of erectile dysfunction (ED) in populations of diabetic men, but few presented data separately for Type 1 and Type 2 subjects. No comparison data for these diabetic subgroups are available with regard to risk factors for ED. METHODS: Eligible for the study were men aged 20-69 years with a diagnosis of insulin-dependent (Type 1) or non-insulin-dependent (Type 2) diabetes who were observed on randomly selected days in 178 diabetes centres in Italy. Erectile dysfunction was defined as a failure to achieve and maintain an erection sufficient for satisfactory sexual performance. RESULTS: The study population consisted of 1383 Type 1 and 8373 Type 2 men. The prevalence of ED increased with age for both groups. After taking into account the effect of age Type 2 men (37/100 men) tend to report ED less frequently than Type 1 men (51/100 men). A significant positive relationship was reported between ED and poor metabolic control and smoking for both Type 1 and Type 2 men, whereas high body mass index (BMI) increased only the risk of ED in Type 1 cases. CONCLUSIONS: The study offers a quantitative estimate of the prevalence of ED and its main risk factors in Type 1 and Type 2 diabetic subgroups.

Adult↗
PubMed1999

Correlates of hormone replacement therapy use in Italian women, 1992-1996.

OBJECTIVES: we analyzed the determinants of hormonal replacement therapy (HRT) use in Italy for the period 1992-1996, using data from a framework of case-control studies of colon and rectal neoplasm. METHODS: a total of 1574 women aged 45-74 years were considered. This group comprised women with acute, non neoplastic, non-hormone-related diseases admitted to a network of hospitals in six areas of Italy. RESULTS: a total of 146 women (8.5%) reported ever HRT use. The multivariate odds ratio (OR) of ever use was 1.6 (95% CI 1.0-2.6) for women with 12 years of education or more, compared with those with < 7 years. The frequency of use of HRT tended to decrease with increasing parity: the OR was 0.6 for women with four or more children as compared to nulliparae (chi2 trend 3.5, P = 0.06). Ever HRT users were more frequently smokers. HRT use was more frequent in women reporting surgical menopause (OR = 2.7) than those with natural menopause. Among post menopausal women, HRT use was related with early age at menopause (chi2 trend 4.6, P = 0.03). HRT use was more common among women reporting lower body mass index (BMI) both at interview and at age 30 years and the difference between current BMI and BMI at age 30 years, was not related with HRT use. CONCLUSIONS: women of higher socioeconomic status or education reported more frequent HRT use and nulliparae and smokers were also more likely to use HRT. Further HRT use was directly associated with early age at menopause and surgical menopause and inversely related with measures of body weight.

Aged↗
PubMed1999

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 > or = 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 > or = 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).

Adult↗
PubMed1999

Hormonal therapy for menopause and ovarian cancer in a collaborative re-analysis of European studies.

The relationship between hormonal therapy for menopause (hormone replacement therapy, HRT) and the risk of epithelial ovarian cancer was evaluated in a collaborative re-analysis of 4 European case-control studies, 2 conducted in Greece and 1 each in Italy and the United Kingdom, including a total of 1,470 ovarian cancer cases and 3,271 hospital controls. Odds ratios (ORs) for HRT use were derived after allowance for study centre, age, socio-economic level, parity, menopausal status, type of menopause, age at menopause and oral contraceptive use. Overall, 109 (8.0%) ovarian cancer cases and 146 (4.7%) controls had ever used HRT, corresponding to an adjusted OR of 1.71 (95% confidence interval 1.30-2.25). The point estimates of the OR were 1.77 in the first Greek study, 1.40 in the second Greek study, 1.66 in the Italian study and 1.68 in the British study. Adjustment for possible confounders, including menopausal status, type of menopause, age at menopause and oral contraceptive use, slightly increased the OR. Limiting the analysis to women with information on relevant aspects of HRT use revealed a weak positive association with duration and some evidence that the excess relative risk for ovarian cancer declined with time since last use. These findings are compatible with a promoting effect of HRT in ovarian carcinogenesis. It is also possible, however, that the positive association reflects chance or selective administration of HRT to high-risk individuals, since until recently in Europe HRT was prescribed mainly for alleviation of peri-menopausal symptoms.

Age Factors↗
PubMed1999

Association of early-stage psoriasis with smoking and male alcohol consumption: evidence from an Italian case-control study.

OBJECTIVE: To analyze the association of psoriasis with smoking habits and alcohol consumption before first diagnosis by a dermatologist. DESIGN: A multicenter case-control study. Interviews were conducted by trained medical investigators using a structured questionnaire. SETTING: Outpatient services of 10 general and 10 teaching hospitals in northern and southern Italy. SUBJECTS: Patients with a first diagnosis of psoriasis made by a dermatologist and a history of skin manifestations of no longer than 2 years after the reported disease onset. Patients with new diagnoses of skin diseases other than psoriasis were selected as control subjects. A total of 404 case patients (median age, 35 years) and 616 controls (median age, 36 years) were included in the analysis. RESULTS: The risk for psoriasis was higher in ex-smokers and in current smokers than in patients who never smoked. The relation with smoking was stronger and more consistent among women than men. In men, a significant association was restricted to the ex-smoker status. Smoking was strongly associated with pustular lesions (29 patients) with an adjusted odds ratio of 10.5 (95% confidence interval, 3.3-33.5) for those smoking more than 15 cigarettes per day. No significant overall association with alcohol consumption was documented after controlling for smoking habits. However, the risk seemed to vary according to sex, with a moderate association being documented in men. CONCLUSIONS: Cigarette smoking and, in men, alcohol consumption are associated with psoriasis. There is a strong association between smoking and pustular lesions.

Adult↗
PubMed1999

Paclitaxel vs epidoxorubicin plus paclitaxel as second-line therapy for platinum-refractory and -resistant ovarian cancer.

We conducted a randomized clinical trial to compare the efficacy and safety of paclitaxel and a combination including paclitaxel and epidoxorubicin as second-line treatment in platinum-refractory or -resistant ovarian cancer. Patients who had progressive or stable disease during first-line therapy with regimens containing cisplatin or carboplatin (platinum-refractory patients) or who responded and subsequently relapsed within 6 months after discontinuation of first-line platinum-based regimen (platinum-resistant patients) were eligible for the study. They were randomly allocated to paclitaxel 175 mg/m2 every 28 days (41 women) for five cycles or epidoxorubicin 120 mg/m2 iv plus paclitaxel 150 mg/m2 iv every 28 days (40 women). The overall response rates (complete plus partial response) were, respectively, 17.1% in the paclitaxel and 34.2% in the epidoxorubicin plus paclitaxel group (P = 0.10). The 2-year percentage survival was 18 in the paclitaxel group and 10 in the epidoxorubicin plus paclitaxel group. A higher frequency of leukopenia and thrombocytopenia was reported in women allocated to epidoxorubicin plus paclitaxel than in the paclitaxel alone group, but the frequency of neurotoxicity was higher in the paclitaxel alone group. An important limitation of the study is the small sample size. With this sample size we can exclude that multiagent therapy in comparison with single-agent therapy improves response in platinum-refractory and -resistant ovarian cancer of more than 25%.

Adult↗
PubMed1999

Pelvic and paraortic lymph nodal status in advanced ovarian cancer and survival.

BACKGROUND: In order to analyze the prognostic role of node involvement in advanced ovarian cancer, we have analyzed data from a randomized clinical trial on advanced ovarian cancer. METHODS: Cases were 456 women who entered a randomized multicentric clinical trial comparing two cisplatin-based schemes of treatment after cytoreductive surgery for advanced stage III-IV ovarian cancer. They underwent selective pelvic and/or paraortic lymphadenectomy. RESULTS: A total of 161 (35.3%) cases had positive nodes. The frequency of positive nodes was statistically significantly higher in FIGO stage IV than in stage III. Also grade 3 tumors were more likely to have positive nodes than grade 1-2 tumors. No association was observed between nodal status and response to chemotherapy. The 3-year survival was 46.2 (standard error (SE) = 3.4 based on 147 deaths) and 44.6 (SE = 4.4, based on 84 deaths), respectively, in negative and positive node groups. The corresponding values, when the analysis was performed considering only subjects with residual tumor <1 cm or absent, after first-line cytoreductive surgery were 66.2 (SE = 5.7) and 62.4 (SE = 9.6). CONCLUSIONS: We did not find any association between nodal status and survival. Particularly, nodal status was not a prognostic factor for survival in the subgroup of women with residual tumor <1 cm or absent after cytoreductive surgery.

Adult↗
PubMed1999

Reasons for contraceptive discontinuation in women 20-39 years old in New Zealand.

To estimate the frequency and the medical and nonmedical reasons for discontinuation of oral contraceptive (OC), intrauterine device (IUD), and injectable depot medroxyprogesterone acetate (DMPA) use, data from a cohort of experienced contraceptive users in New Zealand are reported. The current analysis consists of 2469 OC, 2072 IUD, and 1721 DMPA users followed over a period of 5 years. The percentage of women who discontinued the use of the method within 24 months after entry into the cohort were 42%, 44%, and 48%, respectively, for OC, IUD, and DMPA; these differences were not statistically significant. The most common reasons given for discontinuing a contraceptive method, regardless of which method was in use, were the desire to conceive, patient preference, no longer needing contraception, and vasectomy. Among the medical reasons, menorrhagia and intermenstrual bleeding were the reasons for discontinuing use of the method in 1.5 and 1.1 times per 100 women-years among DMPA users and in 1.8 and 4.7 times per 100 women-years among OC users. Pelvic pain and infection were reasons for discontinuing contraceptive method, respectively, 4.4 and 4.3 times per 100 women-years among IUD users. In conclusion, the present study confirms, in this New Zealand population, the high discontinuation rate of contraceptive methods reported elsewhere. In contrast with previous suggestions, in this study, irregular bleeding was not an important medical reason for discontinuation of DMPA use.

Adult↗
PubMed1999

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.

Adult↗
PubMed1999

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.

Adult↗
PubMed1999

Goserelin acetate to avoid hysterectomy in pre-menopausal women with fibroids requiring surgery.

OBJECTIVE: To obtain information on the efficacy of repeated short cycles of GNRH agonist treatment in order to avoid hysterectomy in near-menopausal women with symptomatic fibroids. STUDY DESIGN: 72 pre-menopausal women (mean age 50 years) with one or more uterine fibroids >10 cm in diameter, symptomatic menorrhagia lasting three months or more and haemoglobin=9 g/dl entered the study. The patients were randomized with ratio of approximately 1:4 to: (a) immediate surgery; or (b) treatment with goserelin acetate. Patients randomized to goserelin acetate received a first cycle of 3.6 mg depot once every 28 days for four months. They were followed-up for three years. If menorrhagia was observed during the follow-up the woman was given goserelin acetate 3.6 mg depot for another three months. In case of further menorrhagia, a third cycle of goserelin acetate 3.6 mg depot for three months was given. After the third cycle of therapy if there was still menorrhagia, the patient underwent hysterectomy plus bilateral oophorectomy. RESULTS: A total of 13 women were assigned to the immediate surgery group and 59 to goserelin. Three years after trial entry a total of 23 women allocated to goserelin acetate treatment had undergone hysterectomy. CONCLUSION: This study suggests that GNRH agonists are efficacious for avoiding hysterectomy in women near menopause with uterine fibroids.

Female↗
PubMed1999

Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi.

In order to analyse the efficacy of resection/ablation of minimal/mild endometriotic lesions for improving fertility, we conducted a randomized clinical trial. Eligible patients were women aged </=36 years who were trying to conceive and had a laparoscopically confirmed diagnosis of minimal/mild endometriosis (stage I or II of the revised American Fertility Society classification) and otherwise unexplained infertility for >/=2 years. Eligible women were randomly assigned to resection or ablation of visible endometriosis (54 patients) or diagnostic laparoscopy only (47 patients). After laparoscopy women tried to conceive spontaneously for 1 year (follow-up period). A total of five women withdrew from the study: three for personal reasons, and two were lost to follow-up. Considering 51 women in the resection/ablation and 45 in the no-treatment group who ended the follow-up period, 12 (24%) in the resection/ablation group and 13 (29%) in the no treatment group conceived; the difference was not significant. Two spontaneous abortions were observed in the resection/ablation group and three in the no-treatment one. Thus the 1 year birth rate was 10 out of 51 women (19.6%) in the resection/ablation group and 10 out of 45 women (22.2%) in the no-treatment group. In conclusion, the results of this study do not support the hypothesis that ablation of endometriotic lesions markedly improves fertility rates.

Adult↗
PubMed1999

Fertility drugs and the risk of breast cancer.

Several studies have investigated the possible relationship between fertility drugs and the risk of breast cancer. To provide further information on this issue, we analysed data from a case control study, conducted in Northern Italy between 1983 and 1991. Trained interviewers identified and questioned 3415 cases (women aged 23-74 years with histologically confirmed breast cancer) and 2916 controls (women aged 21-74 years admitted to the same hospitals for diseases other than malignant, hormonal or gynaecological conditions). Fifty (1.5%) cases and 53 (1.8%) controls reported any history of infertility; the corresponding multivariate odds ratios (OR) of breast cancer was 0.8 [95% confidence interval (CI) 0.5-1.1]. Sixteen (0.5%) cases and 11 (0.4%) controls reported ever using fertility drugs; the corresponding OR was 1.2 (95% CI 0.5-2.6). Allowance for potential confounding factors did not markedly modify these estimates. In conclusion, this study provides reassuring evidence on the absence of an association between fertility drug treatment and breast cancer risk.

Adult↗