Semen quality in relation to pesticides

Semen quality in relation to exposure to currently used pesticides
By:Shanna H. Swan, PhD
University of Missouri-Columbia
6th International Symposium on Environmental Endocrine Disrupters
Sendai, Japan

Background
Normal morphology
Motile sperm
Concentration

The Study for Future Families (SFF)
SFF Recruitment:
Summary of Semen Parameters
We considered these factors
o Age
o Smoking
o History of infertility
o Body mass index (BMI)
o History of STDS

* Ethnicity
* Recent fever
* Abstinence time
* Analysis time
Differences in semen quality were unchanged by adjustment for these factors
How does mid-Missouri differ from Minneapolis ?
% Acres in farms and use of pesticides
Herbicides
Insecticides
Fertilizer
Pesticides applied (acres)
Study hypothesis
Pesticides found more often in MN
Remaining analyses
Pesticides detected more often in cases than controls Percent of men with pesticide > LOD
Two pesticides were weakly associated with sperm count
Dose response for alachlor in MO men
Drinking water is a likely source of exposure
Examining pesticides and semen quality in a second agricultural center
Use of pesticides in IA is greater than MO
Semen quality in Iowa City and other SFF centers
What is needed?
* Urinary pesticide levels in IA men
* Serum levels of pesticides to examine total exposure
* Tap water pesticide levels
* Replication of study in other areas and countries
The Study for Future Families

Semen quality.ppt

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Evidence-based Treatment of Psychotic Depression

Evidence-based Treatment of Psychotic Depression
By:Gregory W. Dalack, MD

The Practice of EBM

Step 1: Asking an answerable question
Step 2: Tracking down the best evidence to answer that question
Step 3: Critically appraise the evidence for validity, size of the effect, and utility of the findings
Step 4: Incorporate the clinical appraisal into our clinical expertise and patient’s individual issues
Step 5: Evaluate and improve steps 1-4 with each new opportunity to apply these principles


Brief case history
Asking answerable clinical questions (CEBM- Oxford)
An answerable clinical question

For patients with psychotic depression...
...is antidepressant treatment alone...
...when compared to antidepressant plus antipsychotic treatment…
...result in greater improvement of depressive/psychotic symptoms?

Search Treatment of Psychotic Depression

Electronic Books
Classic Study
The pharmacological treatment of delusional depression
Search Treatment of Psychotic Depression
Relative Risk: the ratio in the treated group to the risk in the control group (TG/CG)
Conclusions

Evidence-based Treatment of Psychotic Depression.ppt

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Combined Pharmacotherapy and Psychotherapy for Anxiety Disorders

Combined Pharmacotherapy and Psychotherapy for Anxiety Disorders: Is Efficacy Enhanced?
An Evidenced-Based Approach
By: Heide Klumpp, Ph.D.


Components of Evidence-Based Treatment include:
Chambless and Hollon (1998)
Comparison with a no-treatment control group, alternative treatment group, or placebo in a randomized control trial or equivalent time-samples design


Study must have been conducted with:

a) Treatment manual
b) Population, treated for specified problems
c) Reliable/valid outcome assessment measures
d) Appropriate data analysis

Clinical scenario

Family hx
Clinical questions:
Does she meet DSM-IV criteria for Social Phobia?
What’s your Evidenced-Based Treatment plan?
2) Psychotherapy (e.g., cognitive-behavioral treatment)?
3) Combined therapy?

Rationale for combined therapy:

Sources for evidence regarding combined therapy
Results consisted of:
Articles comparing treatment approaches
+ Provides details of research methods and analysis
- Difficult to compare results across different studies

Meta-analytic studies
Literature reviews
Efficacy of combined pharmacotherapy and psychotherapy for Social Phobia
Primary outcome measure:
Clinician rated: Clinic Global Impression Inventory-Social Phobia Scale (CGII-SPS)
Patient rated: CGII-SPS

Response defined as:

1) Overall severity score at final visit in the “no menta
Pharmacotherapy:
Exposure therapy:
Outcome after 24 weeks of treatment
Conclusions:
Points to consider:
Recruitment: two outpatient programs at medical centers
Response primarily via Clinical Global Impressions Improvement (CGII):
Pharmacotherapy: Double-blind administration
Cognitive-behavioral treatment:
Points to consider:
Recruitment: 133 participants from Cognitive behavioral treatment program at an Anxiety Disorders Clinic at a hospital
Pre Post Pre Post
Conclusion:
Points to consider:
Summary
Questions regarding clinical scenario

Combined Pharmacotherapy and Psychotherapy for Anxiety Disorders.ppt

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