Time series analysis of sperm concentration in fertile men in Toulouse, France between 1977 and 1992
Randomised comparison of oestrogen versus oestrogen plus progestogen hormone replacement therapy in women with hysterectomy
Flavonoid intake and coronary mortality in Finland: a cohort study
General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines
Stewart Irvine, Elizabeth Cawood, David Richardson Eileen MacDonald, John Aitken
Abstract
Objective - To determine whether the quality of semen has changed in a group of over 500 Scottish men born between 1951 and 1973.
Design - Retrospective review of data on semen quality collected in a single laboratory over 11 years and according to World Health Organisation guidelines.
Setting - Programme of gamete biology research funded by Medical Research Council.
Subjects - 577 volunteer semen donors. Of these, 171 were born before 1959, 120 were born in 1960-4,171 in 1965-9, and 115 in 1970-4.
Main outcome measures - Conventional criteria of semen quality including semen volume (ml), sperm concentration (10 to power six/ml), overall motility (%motile), total number of sperm in the ejaculate (10 to power six), and total number of motile sperm in the ejaculate (10 to power six)
Results - When the four birth cohort groups were compared a later year of birth was associated with a lower sperm concentration, a lower total number of sperm in the ejaculate, and a lower number of motile sperm in the ejaculate. The median sperm concentration fell from 98x10 to power six/ml among donors born before 1959 to 78x10 to power six/ml among donors born after 1970 (P=0.002). The total number of sperm in the ejaculate fell from 301x10 to power six to 214x10 to power six (P=0.0005), and the total number of motile sperm in the ejaculate fell from l69.7x10 to power six to 129.0x10to power six (P=0.0065).
Conclusion - This study provides direct evidence that semen quality is deteriorating, with a later year of birth being significantly associated with a reduced number of sperm in adult life.
Medical Research Council Reproductive Biology Unit Centre for Reproductive Biology Edinburgh EH3 9EW Stewart Irvine consultant Elizabeth Cawood scientific officer David Richardson research officer John Aitken professor
Reproductive Medicine Laboratories University of Edinburgh Centre for Reproductive Biology Edinburgh EH3 9EW Eileen MacDonald medical laboratory scientific officer
Correspondence and requests for reprints to: Dr Irvine.
Time series analysis of sperm concentration in fertile men in Toulouse, France between 1977 and 1992
L Bujan, A Mansat, F Pontonnier, R Mieusset
Abstract
Objective - To investigate whether sperm production has changed during the past 16 years in the Toulouse area of France.
Design - Time series analysis of sperm donors' specimens between 1977 and 1992.
Setting - Sperm bank of university hospital in Toulouse, France.
Subjects - 302 healthy fertile men candidate sperm donors more than 20 and up to 45 years old and without any infertile brothers.
Main outcome measure - Spermatozoa concentration.
Results - Donors' mean age at time of donation was 34.05 (SD 5.13), but this increased significantly (P less than 0.001) during the study, from 32.4 in 1977 to 36 in 1992. Mean sperm count of samples was 83.12x10 to power six/ml (SD 68.42x10 to power six/ml). Sperm concentration was positively linked to the year of donation (Pearson's coefficient r equals 0.12, P less than 0.05), but this correlation disappeared after adjustment for age of donors (r equals 0.09, P greater than 0.05).
Conclusion - Sperm concentration has not changed with time in the Toulouse area.
CECOS Midi-Pyrenees and Centre de Sterilite Masculine Centre Hospitalier Universitaire La Grave 31052 Toulouse France L Bujan associate professor of reproductive biology A Mansat associate professor of reproductive biology F Pontonnier professor of urology R Mieusset associate professor of histology
Correspondence to: Dr Bujan.
Randomised comparison of oestrogen versus oestrogen plus progestogen hormone replacement therapy in women with hysterectomy
Medical Research Council's General Practice Research Framework
Abstract
Objective - To compare the acceptability and symptomatic and metabolic effects of two regimens of hormone replacement therapy in women with hysterectomy.
Design - Randomised, double blind comparison.
Setting - Seven group practices in the Medical Research Council's general practice research framework.
Subjects - 321 women with hysterectomy aged 35-59.
Interventions - Hormone replacement therapy with (a) conjugated equine oestrogen 625 mu g daily alone or (b) conjugated equine oestrogen 625 mu g daily plus the progestogen norgestrel 150 mu g daily for the last 12 days of the "cycle."
Main outcome measures - Changes in blood pressure, weight, symptoms, and haemostatic and lipid values.
Results - After two years 36% (57/158) of women randomly allocated to take oestrogen alone had discontinued treatment as compared with 30% (49/163) of women allocated to take oestrogen plus progestogen. Smokers were more likely to withdraw than non-smokers. There were no clear differences between the two groups in symptoms often attributed to hormone replacement therapy or in blood pressure or weight. At one year low density lipoprotein cholesterol concentrations had fallen substantially in both groups. High density lipoprotein cholesterol concentrations rose to significantly higher values in women taking oestrogen alone compared with those taking oestrogen plus progestogen, though triglyceride concentrations and factor VII activity were also significantly higher in this group. Fibrinogen concentration tended to fall, though not significantly, in both groups, possibly more in women taking oestrogen alone.
Conclusion - Oestrogen plus progestogen was no less well tolerated than oestrogen alone. There was a fairly even balance between possibly beneficial and adverse effects of the two regimens on lipid concentrations and coagulability. Concern that the combined regimen may not have the cardioprotective effects ascribed to oestrogen alone can to some extent be allayed, with reassurance for the growing numbers of women with intact uteri using the combined regimen. Misgivings about the combined regimen in women with hysterectomy on the grounds of its acceptability and its effects on lipid values may also be unfounded.
Correspondence to: Professor TW Meade MRC Epidemiology and Medical Care Unit Wolfson Institute of Preventive Medicine St Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, London EC1M 6BQ.
Flavonoid intake and coronary mortality in Finland: a cohort study
Paul Knekt, Ritva Jarvinen, Antti Reunanen, Jouni Maatela
Abstract
Objective - To study the association between dietary intake of flavonoids and subsequent coronary mortality.
Design - A cohort study based on data collected at the Finnish mobile clinic health examination survey from 1967-72 and followed up until 1992.
Setting - 30 communities from different parts of Finland.
Subjects - 5,133 Finnish men and women aged 30-69 years and free from heart disease at baseline.
Main outcome measures - Dietary intake of flavonoids, total mortality, and coronary mortality.
Results - In women a significant inverse gradient was observed between dietary intake of flavonoids and total and coronary mortality. The relative risks between highest and lowest quarters of flavonoid intake adjusted for age, smoking, serum cholesterol concentration, blood pressure, and body mass index were 0.69 (95% confidence interval 0.53 to 0.90) and 0.54 (0.33 to 0.87) for total and coronary mortality, respectively. The corresponding values for men were 0.76 (0.63 to 0.93) and 0.78 (0.56 to 1.08), respectively. Adjustment for intake of antioxidant vitamins and fatty acids weakened the associations for women; the relative risks for coronary heart disease were 0.73 (0.41 to 1.32) and 0.67 (0.44 to 1.00) in women and men, respectively. Intakes of onions and apples, the main dietary sources of flavonoids, presented similar associations. The relative risks for coronary mortality between highest and lowest quarters of apple intake were 0.57 (0.36 to 0.91) and 0.81(0.61 to 1.09) for women and men, respectively. The corresponding values for onions were 0.50 (0.30 to 0.82) and 0.74 (0.53 to 1.02), respectively.
Conclusion - The results suggest that people with very low intakes of flavonoids have higher risks of coronary disease.
National Public Health Institute Mannerheimintie 166 00300 Helsinki Finland Paul Knekt head of laboratory Antti Reunanen head of laboratory
Department of Clinical Nutrition University of Kuopio Kuopio Finland RitvaJarvinen lecturer
Research and Development Centre Social Insurance Institution Helsinki and Turku Finland Jouni Maatela chief physician
Correspondence to: Dr Knelt.
General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines
Paul Little, Lisa Smith, Ted Cantrell, Judith Chapman, John Langridge, Ruth Pickering
Abstract
Objective - To compare general practitioners' reported management of acute back pain with "evidence based" guidelines for its management.
Design - Confidential postal questionnaire.
Setting - One health district in the South and West region.
Subjects - 236 general practitioners; 166 (70%) responded.
Outcome measures - Examination routinely performed, "danger" symptoms and signs warranting urgent referral, advice given, and satisfaction with management.
Results - A minority of general practitioners do not examine reflexes routinely (27%, 95% confidence interval 20% to 34%), and a majority do not examine routinely for muscle weakness or sensation. Although most would refer patients with danger signs, some would not seek urgent advice for saddle anaesthesia (6%, 3% to 11%), extensor plantar response (45%, 37% to 53%), or neurological signs at multiple levels (15%, 10% to 21%). A minority do not give advice about back exercises (42%, 34% to 49%), fitness (34'!., 26'!, to 41%), or everyday activities. A minority performed manipulation (20%) or acupuncture (6%). One third rated their satisfaction with management of back pain as 4 out of 10 or less.
Conclusion - The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting of evidence.
Primary Care Faculty of Medicine Health, and Biological Sciences University of Southampton Southampton S016 55T Paul Little GP Wellcome training fellow
Southampton Hospitals NHS Trust Southampton S016 6YD Lisa Smith research physiotherapist Ted Cantrell consultant rheumatologist John Langridge manager of physiotherapy services
School of Occupational Therapy and Physiotherapy University of Southampton Southampton S017 1BJ Judith Chapman lecturer in physiotherapy
Medical Statistics and Computing University of Southampton Southampton S016 6YD Ruth Pickering lecturer in medical statistics
Correspondence to: Dr Little