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Understanding The Effects Of Sildenafil Treatment On Erection Maintenance And Erection Hardness
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UroToday.com - In our recent article published in the Journal of Sexual Medicine, we used statistical modeling to make the first-reported estimate of the extent to which treatment of erectile dysfunction (ED) affects erection maintenance directly versus indirectly via erection hardness. Because erection maintenance (along with erection hardness) is a physiologic requirement for satisfactory sexual performance, our aim was to guide treatment goals toward optimizing erection maintenance and therefore achieving successful sexual intercourse.

Our statistical models (longitudinal modeling, mapping, and mediation modeling) explored the interrelationships among effective treatment of ED, erection hardness, and erection maintenance in men with ED, using patient reported outcomes from a multinational randomized, double-blind placebo-controlled trial of fixed-dose online pharmacy viagra (100 or 50 mg, 8 wk) with open-label extension of flexible-dose sildenafil (50 and 100 mg, 4 wk). Longitudinal models obtain measurements on the same individuals repeatedly through time to estimate within-individual changes in the response variable and to relate these changes to inter-individual differences in selected covariates (eg, treatment group). Mapping enables interpretation of an outcome of interest (eg, erection maintenance) in terms of a known outcome (eg, erection hardness). A mediation model seeks to identify and explain the mechanism that underlies an observed relationship between an independent variable (eg, treatment) and a dependent variable (eg, erection maintenance) via the inclusion of a mediator variable (eg, erection hardness). The mediator variable clarifies the nature of the interrelationships among variables. In our models, measures of interest included the Erection Hardness Score (EHS) to gauge erection hardness and the two maintenance items (items 4 and 5) on the International Index of Erectile Function (IIEF) to gauge erection maintenance (see Tables). Separate models were implemented for each of the two maintenance items.

Maintenance: International Index of Erectile Function

Item 4: During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?

Item 5: During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?

Hardness: Erection Hardness Score

"How would you rate the hardness of your erection?"

0: Penis does not enlarge.

1: Penis is larger but not hard.

2: Penis is hard but not hard enough for penetration.

3: Penis is hard enough for penetration but not completely hard.

4: Penis is completely hard and fully rigid.

Longitudinal mean differences on the outcomes for sildenafil 100 and 50 mg vs. placebo (in the double-blind phase) were high (P<0.0001 for each), with large standardized effect sizes (>0.8).

For the mapping of erection hardness (EHS) onto maintenance (items 4 and 5 on IIEF), which included all available data and combined all treatment groups, correlations between EHS and IIEF items 4 and 5 ranged from 0.54 to 0.73 - and the mapping of the relationship between EHS and IIEF items 4 or 5 can be approximated as linear.

In our mediation model, which used data in the double-blind portion and pooled sildenafil into one active treatment, erection hardness was defined by the EHS and erection maintenance was defined by item 4 and, separately, by item 5 on the IIEF. The indirect effect of sildenafil treatment (vs. placebo) via erection hardness accounted for 55.4% (standard error [SE]=7.9%) and 43.1% (SE=6.8%) of the total effect of sildenafil treatment on IIEF maintenance item 4 and item 5, respectively, whereas the direct effect of treatment on IIEF items 4 and 5 was 44.6% (SE=7.9%) and 56.9% (SE=6.8%), respectively (P<0.0001 for each).

Sildenafil treatment significantly improved erection maintenance, a physiologic requirement for satisfactory sexual performance. According to our model, only approximately half of the effect of sildenafil on erection maintenance was estimated to be driven through direct effects. Rather, the effect of sildenafil on erection maintenance seems to be substantially driven by erection hardness. Therefore, achievement of optimal initial erection hardness appears to be an important treatment goal for enhancing erection maintenance and achieving successful ED treatment.

Written by Hubert IM Claes, MD, PhD,* Irwin Goldstein, MD,† Stanley E. Althof, PhD,‡ Michael M. Berner, MD,§ Joseph C Cappelleri, PhD, MPH,** Andrew G Bushmakin, MS,** Tara Symonds, PhD,†† and Gabriel Schnetzler, MD‡‡ as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

Department of Urology, University Clinics Gasthuisberg, Leuven, Belgium; †Sexual Medicine, Alvarado Hospital and Department of Surgery, University of California at San Diego, CA, USA; ‡ Miller School of Medicine, University of Miami, Miami, FL,USA; §University Hospital Medical Center, Freiburg, Germany; **Pfizer Inc, Global Research & Development, New London, CT, USA; ††Pfizer Ltd Outcomes Research, Sandwich, UK; ‡‡Pfizer International Operations, Paris, France

Acknowledgments:

The study on which this report is based was sponsored by Pfizer Inc. Editorial support was provided by Deborah M. Campoli-Richards, BSPHA, RPh, of Complete Healthcare Communications, Inc., and was funded by Pfizer Inc.

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2010 - UroToday

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Why the day after Christmas is a health hazard
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December 26 could be one of the most dangerous days of the year for people vulnerable to cardiac problems, including heart attacks, arrhythmias, and heart failure. And many of these so-called Merry Christmas coronaries will hit people who didn't even realize they were at risk when they unwrapped their gifts the night before.

But the holiday season isn't good for heart health to begin with. A 2004 study by researchers at the University of California, San Diego and Tufts University found that heart-related deaths increase by nearly 5 percent during the holidays, perhaps because patients delay seeking treatment for heart problems or because cheap cialis staffing patterns change. But anecdotally, doctors say that their ERs stay quiet on Christmas Day itself. Then, come December 26, they see a surge of cardiac traffic.

"This time of year is notorious for heart attacks, heart failures, and arrhythmias," says Samin Sharma, MD, director of interventional cardiology at Mount Sinai Medical Center in New York.

In fact, 2008 may pose an even greater risk than years past. Added stress over the recession means you're already putting a lot of pressure on your heart, and that's before the holiday eating and drinking even begin. Here's how to steer clear of the hospital. Health.com: Heart-healthy holiday menu

Keep your ticker ticking

It's easy to knock back several glasses of wine when you're sitting around the holiday table for long stretches of time, especially if you tell yourself that wine is good for your heart. But more than one alcoholic drink can have consequences: Excessive drinking can trigger atrial fibrillation, or an irregular heartbeat. If it persists, atrial fibrillation ups your odds of suffering a stroke. "There are huge campaigns not to drink and drive during the holidays, but no one talks about the heart dangers," says Dr. Sharma.

Extra money woes coupled with an already stressful holiday season sound like a setup for overindulgence. "It's probably more dangerous than ever this year," says Gerald Fletcher, MD, a cardiologist at the Mayo Clinic in Rochester, Minnesota. "People don't have as much money, but they still need to spend. They're cutting back, but they're worried about the credit card bill on the way. With all this in mind, people might be drinking more than ever." Health.com: What are your odds of a heart attack?

Normally, a holiday heart arrhythmia isn't fatal, and in fact it usually fades on its own. Some of the symptoms are the same as a hangover -- nausea, weakness, and a pale face -- and your heart should be back to normal in 24 hours. But if it isn't, you may need to see a doctor for medication or electrical cardioversion, which will stabilize your heart beat.

How to avoid a holiday heart attack

Every year, cardiologists see a spike in heart attacks once the weather starts to turn. When temperatures drop, blood vessels start to restrict, raising blood pressure. You may want to think twice before you decide to shovel your stoop or take a postprandial hike in bitter weather, as strenuous physical activity can leave you clutching your chest.

But cold weather isn't the only culprit. Come Christmas Day, many people confuse the signs of a heart attack -- like shortness of breath or chest pains -- with indigestion from a big dinner. And while you may be apt not to risk it on any other day, hauling yourself down to the hospital may seem like too much of a hassle on a big holiday.

Instead, many people ignore the telltale signs of a heart attack until they wake up on the 26th, still feeling that discomfort. But by then it may be too late.

"If you're having a heart attack, studies show that you can't wait longer than 12 hours to be treated," says Dr. Sharma. So if you wait until December 26, you may be playing with your fate. Health.com: Surprising heart attack triggers

Listen to your body over the long holiday haul and don't dismiss any discomfort as a by-product of overindulgence. Watch any friends or family members who have had a heart attack in the past.

Breaking diet rules and heart failure

Patients with heart failure who are following a low-sodium diet need to exercise extra caution this Christmas. Experts say that these people may choose not to live within their everyday rules, opting to partake in holiday overindulgences instead. Heavy meals, too much salt, and excess alcohol can all trigger heart failure. Health.com: Learning to eat healthy can be work

"Doctors need to make a point of telling their patients not to overindulge," says Dr. Sharma. "Ultimately, though, it's the patients who are going to decide what to do."

But everyone, not just heart patients, can benefit from watching what they eat. "We need to try to stay healthy through the holidays, not wait until January 1," says Dr. Fletcher. "You can't keep your resolution if you don't live through the holidays."

Source: http://www.cnn.com/2008/HEALTH/conditions/12/18/healthmag.moh.dec26/


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A friend heard this on the radio this morning and passed it on to my Growing Old Disgracefully email group. Another member responded with the following animation, suggesting that it is more appropriate to our organisation than the joke on the radio. I have to agree. [It's not new, but it's still funny.]

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"Have you heard about the new high speed Stanna Stair Lift?

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A friend heard this on the radio this morning and passed it on to my Growing Old Disgracefully email group. Another member responded with the following animation, suggesting that it is more appropriate to our organisation than the joke on the radio. I have to agree. [It's not new, but it's still funny.]

Disgraceful stairlift


And here's another chairlift cartoon I am rather fond of. I think it came from The Oldie Magazine originally. If so, I hope they will consider themselves acknowledged hereby.




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Disgraceful stairlift
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"Have you heard about the new high speed Stanna Stair Lift?

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A friend heard this on the radio this morning and passed it on to my Growing Old Disgracefully email group. Another member responded with the following animation, suggesting that it is more appropriate to our organisation than the joke on the radio. I have to agree. [It's not new, but it's still funny.]

Disgraceful stairlift


And here's another chairlift cartoon I am rather fond of. I think it came from The Oldie Magazine originally. If so, I hope they will consider themselves acknowledged hereby.




PLEASE HAVE THE COURTESY NOT TO LEAVE COMMERCIALS FOR generic viagra AND SIMILAR DRUGS ON MY BLOG - THANKYOU


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See also: generic cialis | 


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"Have you heard about the new high speed Stanna Stair Lift?

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A friend heard this on the radio this morning and passed it on to my Growing Old Disgracefully email group. Another member responded with the following animation, suggesting that it is more appropriate to our organisation than the joke on the radio. I have to agree. [It's not new, but it's still funny.]

Disgraceful stairlift


And here's another chairlift cartoon I am rather fond of. I think it came from The Oldie Magazine originally. If so, I hope they will consider themselves acknowledged hereby.




PLEASE HAVE THE COURTESY NOT TO LEAVE COMMERCIALS FOR viagra AND SIMILAR DRUGS ON MY BLOG - THANKYOU


Viva Viagra
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If you've not seen the commercial, check it out here...

Ah... You're back. What did you think?

Apparently, others have noted this commercial and hate it - I would guess that most of those would be the ones who don't really watch TV, but have it on as background noise; and those who think Elvis was a god; and those who think that songs cannot be parodied or certain songs or those by certain people should not be used in ANY commercials. I was looking around on the net to figure out 1) who sang the song; and 2) who were the actors in the commercial (and did THEY sing it?) Although there are about 50,000 Google-searched links out there that mention "Viva Viagra", only one place mentioned that it MIGHT be "the Swinging Johnsons/Johnson Brothers" singing it. (And THAT might very well be a tongue-in-cheek reply!) But in leafing through the pages of the Google results and spot-checking a few, I found a lot of people don't like the commercial!

  • Some think it's creepy... There are a buncha guys in an old garage or shop, singing about viagra, and there's not a chick in sight! But they say nothing about all the other garage bands out there, who practice without their girlfriends, wives, kids, etc. And many of them still do sing love songs. Why isn't THAT creepy? LOL
  • Some think it's irresponsible of Pfizer to promote cialis this way - You know... a fun, well-done parody of a popular song, with no mention that Viagra doesn't stop STDs. Well, I like this approach MUCH better than the creepy 50s father with the adoring wife and stupid open-mouth grin on his face because he's FOUND Viagra! GEEZE! Talk about creepy!
  • Still others think it promotes the use of Viagra as a "recreational" drug, for those who don't have ED, especially using the Viva Las Vegas song... That except for one or two of the guys in the commercial, most are in the late 40s and early 50s and shouldn't NEED it. (After all... Didn't Bob Dole and a couple of other octagenarians advertise it?) Well, think about this... There are other diseases and treatments that otherwise healthy men of ANY age can "get" and have, that can cause ED - diabetes and high blood-pressure to name two. There are also medical treatments that can cause ED. If Viagra or one of the other ED drugs can be used and help, if YOU had the problem, wouldn't YOU want to use them?
  • And there are those that think Viagra is too well-known to advertise. Are you shitting me? What about Aspirin? Doesn't EVERYBODY know that aspirin can help when you're having a stroke or heart attack? Doesn't EVERYBODY know that it helps aches and pains? So why are THEY still advertising? Doesn't EVERYBODY know know that BEEF... is for dinner? That milk does a body good? That Wonder Bread helps build strong bones? That Pork is the "other white meat"? That... So why are we still seeing advertisements for them?
Personally, I like it. I know... I know... I've just blasphemed about the god Elvis and his works, but forget THAT for a moment... and forget for a moment that it's a Viagra commercial - The song is really well-done... The edits in the commercial are well-done... The actors in the commercial (I swear I've seen at least 3-4 of them in SOMETHING (separately, of course)), "fit the part", look like they're really singing the song (if they aren't), and are obviously having a blast being in a band. (All you guys and girls my age who used to play an instrument, or still do, and aren't IN a band... Doesn't it make you want to try to start a band like that? And NO... We would NOT be singing "Viva Viagra"!) And you and those who are CURRENTLY in bands - Don't you wish you had a place out in the boonies where you could practice without the neighbors limiting when you could, and possi-proba-bly calling the cops on you for being loud?

Give it a break and get over it. It's a freaking commercial. If you can't sit through 30-60 seconds of something you don't like... It's almost as bad as those people who change channels on the radio when a song they don't like plays... It's only going to be on for 3-5 minutes. Turn it down enough to just hear when it's over! GEEZE! If you don't like a commercial, when it starts, pick your butt up off the couch and go to the bathroom... Let or take the dog out... Go to the kitchen and get a drink or something to munch on... Read a story in the paper... SOMETHING... And QUICHERBICHIN!

Oh, yeah... Anyone know who sings the song and who the actors in the commercial are? I'd really like to know.

Speaking of drug commercials - Has anyone else noticed the prolifieration of drug dealers on the street? Sure... They're over-the-counter drugs, but they are still drug dealers giving out "free samples", right? The Zantac (FAST) guy? All those people who notice a family member/friend/collegue in distress and say "try this" medicine? Anyone remember the Phillips Milk of Magnesia lady? Why isn't anyone going after them. And no... Those advertising a drug by describing it are not the same. Think about it.

Ok... 'nuff for now.

-wds


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