Sperm quality is deteriorating in Britain...
The notion that human semen quality is deteriorating has attracted much interest and provoked considerable controversy. A recent study of selected fertile men in France suggested that semen quality was falling by over 2% per year. On p 461 Irvine et al report the results of a retrospective survey of 577 volunteer semen donors participating in a British programme of gamete biology research in Edinburgh. They found that a later year of birth was associated with a lower sperm concentration, a lower total number of sperm per ejaculate, and a lower number of motile sperm per ejaculate. When they compared men born in the 1970s with those born in the 1950s the median total number of motile sperm per ejaculate was reduced from l69.7x10 to power six to 129x10 to power six, a fall of almost 25%.
... but counts have not declined in south west France
A decline in sperm count was recently confirmed in Paris. Bujan et al (p 471) studied the sperm production of healthy fertile men in the Toulouse area of south west France. The men were recruited according to the same selection criteria as in the Parisian study. However, contrary to the Parisian results, the sperm count had remained constant during the past 16 years. These findings could be explained by different environmental conditions in the two areas.
Reservations about opposed HRT may be unfounded
Norgestrel, the relatively androgenic progestogen in the most widely prescribed hormone replacement preparation, is commonly thought to be poorly tolerated and to have potentially harmtul metabolic effects. On p 473 the Medical Research Council's general practice research framework reports a randomised comparison of hormone replacement therapy containing oestrogen only and opposed norgestrel in women who had had a hysterectomy. Opposed treatment was as well tolerated as the oestrogen only regimen and there was little difference in their lipid and haemostatic effects. Comparison of the results with those of the recently published postmenopausal oestrogen/progestin interventions (PEPI) trial in the United States suggests there may also be little difference between norgestrel and the less androgenic medroxyprogesterone acetate in their metabolic effects. Pending the results of clinical end point trials, anxieties about the metabolic effects and perhaps the tolerability of norgestrel can largely be allayed.
Apples and onions may prevent heart disease
Flavonoids are biologically active plant products with antioxidant properties.
The role of flavonoids in protection against coronary heart disease is implicated
but their importance in human nutrition is still uncertain. A Finnish group has
investigated differences in coronary mortality at different levels of intake of
flavonoids in a population study. Knekt et al (p 478) found that low intake of
flavonoids or fruits and vegetables rich in flavonoids was associated with an
increased risk of dying from heart disease. The association was observed within a
population with very low intake. Their findings may help explain the inverse
association between intakes of fruit and vegetables and the incidence of heart
disease.
GPsÕ management of low back pain does not match guidelines
To assess the match between the recommendations of several sets of clinical guidelines on managing acute back pain and what general practitioners actually do Little et al (p485) surveyed 236 general practitioners in one health district in England. Among the 166 who responded most do not routinely perform some aspects of the recommended examinations, a minority do not give advice about exercise or daily activities, and a minority do not urgently refer for some danger signs. The authors point out, however, that little of the evidence on which the guidelines are based comes from studies in general practice. They do recommend, however, that general practitioners need clear advice on the danger symptoms that should prompt an urgent referral.