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People with high blood pressure who want to reduce their risk of having a stroke or dying prematurely should get their prescriptions filled and see their doctor regularly.

In a large study of Medicaid patients, researchers found that the more closely a person adhered to his or her doctor’s recommendations for filling their blood pressure medication prescription, the lower his or her risk of stroke and death.

Taking just one more pill as recommended each week (from a one-a-day regimen) cut stroke risk by 9 percent and death risk by 7 percent, Dr. James E. Bailey of the University of Tennessee Health Science Center in Memphis and colleagues report in the Journal of General Internal Medicine.

They looked at the medical records of about 49,000 Tennessee Medicaid patients for 1994 to 2000 to determine if blood pressure medication refill adherence or frequency of physician visits influenced risk of stroke or death. The researchers also investigated whether the type of blood pressure-lowering drugs a patient took was associated with stroke or risk of dying.

Patients were taking two different types of blood pressure drug on average, although some were taking as many as six. Sixty percent of the patients filled their prescriptions less than 80 percent of the time, and were classified as non-adherent to their medication.

During follow-up, which ranged from 3 to 7 years, 619 study participants had a stroke and 2,051 died.

Patients who were non-adherent were a half-percent more likely to die over a five-year period compared to adherent patients. Blood pressure drugs known as thiazide diuretics, ACE inhibitors, calcium channel blockers and beta blockers all cut death risk by 3 to 4 percent, while thiazide diuretics also cut stroke risk.

“This study demonstrates that medication adherence, a factor very amenable to change, is among the most important cardiovascular risk factors” for people with high blood pressure, Bailey and his colleagues note.

Based on the findings, they say, increasing US patients’ refill adherence to 80 percent or greater could save about 200,000 lives over the next five years.

Patients in the study averaged about five doctor office visits a year, although there was a wide range, with some not seeing a doctor at all and others logging nearly 90 visits a year.

Patients who visited the doctor more often were 1 percent less likely to die, even after the researchers took other illnesses into account, a finding they call “striking.”

While the benefit was small, the researchers note, this study is the first to their knowledge to give “clear evidence” that office visits are beneficial for patients with high blood pressure.

SOURCE: Journal of General Internal Medicine.

Men who physically abuse their partners overestimate how often such violence occurs, which helps them justify their own actions, according to a new study.

University of Washington researchers looked at 124 men enrolled in a larger study of treatment intervention for domestic violence. The men, who had committed violence against a partner in the previous 90 days, were asked to estimate the percentage of men who had ever engaged in seven forms of abuse: throwing something at a partner that could cause injury; pushing, grabbing or shoving a partner; slapping or hitting; choking; beating up a partner; threatening a partner with a gun; or forcing a partner to have sex against their will.

The men overestimated by two to three times the actual rates of the seven forms of abuse. For example, the participants on average believed that about 28 percent of men had thrown something with the intent of hurting a partner, but the actual rate in the United States is around 12 percent. The men also believed that close to 24 percent of men had forced a partner to have sex, compared to the actual rate of near 8 percent.

The study is published in the April issue of the journal Violence Against Women.

“We don’t know why men make these overestimations, but there are a couple of likely reasons,” lead author Clayton Neighbors said in a news release. “Men who engage in violent behavior justify it in their mind by thinking it is more common and saying, ‘Most guys slap their women around so it is OK to engage in it.’ Or it could be that misperceptions about violence cause the behavior,”

“Another way of looking at this would be wearing a red shirt. If you think everyone is wearing a red shirt then it is okay for you to wear one too. Or if you wear a red shirt you might overestimate the number of other people who are wearing red shirts,” said Neighbors, a UW affiliate professor of psychiatry and behavioral sciences and a professor of psychology at the University of Houston.

“The more we can correct misconceptions about the prevalence of intimate partner violence, we have a chance to change men’s behavior. If you give them factual information, it is harder for them to justify their behavior,” he added.

SOURCE: University of Washington, news release.

Researchers launched a unique collaboration on Wednesday aimed at getting cancer drugs to the market more quickly in which three companies will cooperate with the U.S. government and non-profit groups to test five experimental breast cancer drugs.

The five-year, $26 million study called Investigation of Serial Studies to Predict your Therapeutic Response with Imaging and Molecular Analysis, or I-SPY2, will aim to use DNA to match the best drug to each patient and to more quickly toss out approaches that do not work or are too toxic.

“They’ll get the latest and greatest in terms of targeted drugs,” Dr. Anna Barker, deputy director of the National Cancer Institute, said in an interview.

“I think it’s the future. Government couldn’t have done it on their own and these companies couldn’t have done it on their own.”

Unusually, the companies agreed to share information on using genes to predict how well a patient will respond as part of the Biomarkers Consortium, which includes the U.S. Food and Drug Administration and the National Institutes of Health.

“I-SPY 2 will provide a path to personalized medicine,” said Dr. Laura Esserman, a breast cancer surgeon at the University of California San Francisco who will help lead the clinical trials. “We intend that every drug will graduate with a companion marker.”

The trial will match patients to one of five experimental drugs:

– ABT-888 or veliparib, being developed by Abbott Laboratories. The pill is a PARP inhibitor, which blocks a cell repair enzyme used by cancer cells.

– AMG 655 or conatumumab, a targeted drug being developed by Amgen. It boosts a protein called APO/TRAIL that causes cancer cells to self-destruct.

– Amgen’s AMG 386, an angiogenesis inhibitor that stops tumors from growing blood vessels to nourish themselves.

– CP-751,871 or figitumumab, being developed by Pfizer Inc to target the insulin growth factor receptor or IGFR.

– Pfizer’s HKI-272 or neratinib, another targeted therapy called a Pan ErbB inhibitor that targets several related receptors used by cancer cells.

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The group is negotiating with other companies to add their experimental drugs to the mix.

“It’ll speed up the whole process,” Barker said.

The drug company lobby group PhRMA estimates it can take as long as 15 years and cost more than $1.3 billion dollars to take a new drug from laboratory to pharmacy.

Patients at 20 cancer centers will be tested right after they get tiny samples of tissue taken in biopsies. Before they ever get surgery, they will be treated with one of the drugs to see if this helps prevent tumor spread.

Up to 12 different cancer drugs will be tested. Unusually, the group has FDA approval to drop and add drugs throughout the course of the trial without having to stop it to write a whole new protocol.

Safeway Inc’s charitable foundation is paying for a large part of the experiment. Johnson & Johnson, Roche AG subsidiary Genentech and Eli Lilly and Co will also provide funding.

“This approach could apply to other diseases and other cancer,” said Barker.

The approach could save the U.S. healthcare system money, said University of California San Francisco Chancellor Dr. Sue Desmond-Hellmann.

“It has the opportunity to make clinical trials more efficient so we will spend less to develop new remedies,” Desmond-Hellmann, a former drug company executive, said in a telephone interview. “I predict that companies will be watching this.”

More information is available at http://www.ispy2.org.

(Editing by John O’Callaghan)

People with irritable bowel syndrome (IBS) aren’t at increased risk for polyps, colon cancer or inflammatory bowel diseases, such as Crohn’s disease and, in most cases, don’t require a colonoscopy, U.S. researchers say.

Symptoms of IBS, which affects 10 percent to 20 percent of Americans, include recurrent abdominal pain or cramping in connection with altered bowel habits. The condition is more common among women than men.

“Patients and doctors get nervous about the symptoms of irritable bowel syndrome. They think the symptoms represent something more sinister,” lead author Dr. William D. Chey, professor of internal medicine at the University of Michigan Medical School, said in a news release from the school. “This study should reassure doctors and patients that typical IBS symptoms are not indicators of a more serious disease.”

He and his colleagues conducted the largest evaluation of the results of colonoscopies in IBS patients, they said. About one-quarter of all colonoscopies performed in the United States are for IBS-related symptoms.

Chey and his team concluded that colonoscopies aren’t necessary for typical cases of IBS, unless there is a family history of colorectal cancer or the patient has alarming symptoms such as unexplained weight loss or anemia, or bleeding from the gastrointestinal tract.

“Lay people and doctors overuse colonoscopies, which are very expensive procedures, in patients with typical IBS symptoms and no alarm features. Of course, patients over the age of 50 years or who have alarm features should undergo colonoscopy to screen for polyps and colon cancer,” Chey said.

The researchers did find that 2.5 percent of IBS patients older than 35 had a disease called microscopic colitis, which can be mistaken for IBS in patients with diarrhea. It’s important to diagnose this condition because it requires different treatment than IBS, Chey said.

The study was released online in advance of publication in an upcoming print issue of the American Journal of Gastroenterology.