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Is screening or treatment for prostate cancer the reason for decreased mortality in the USA, compared to the UK?
The striking decline in prostate cancer mortality in the USA, compared with the UK in 1994-2004, coincided with a much higher uptake of screening in the USA.
Nevertheless, conclude researchers at the University of Bristol, speculation over the role of screening and treatment for prostate cancer will continue until evidence from randomised controlled trials is published. Their study and conclusions are published online (17 April) in The Lancet Oncology.
In the USA, prostate cancer screening based on the prostate-specific antigen (PSA) test, is almost routine. In 2001, 57% of men aged 50 years or older reported having a PSA test within the previous 12 months. By contrast, for each year between 1999 and 2002, an estimated 6% of men aged 45-84 were tested in the UK.
However, there is no robust evidence that routine PSA testing decreases prostate cancer mortality. Previously published comparisons of USA/UK prostate cancer trends - using data up to the late 1990s - showed that mortality rates in the USA and UK had begun to fall, albeit more rapidly in the USA, but the changes seemed too early to be attributed to the effect of PSA testing.
Simon Collin, from the University of Bristol, UK, and colleagues analysed trends in prostate cancer mortality in both countries between 1975 and 2004, and compared them with trends in screening and treatment.
They found that mortality rates peaked in the early 1990s and then began to decline, but after 1994, the rate of decline of mortality in the USA (4.17% per year) was almost four times that in the UK (1.17% per year). The mortality decline in the USA was greatest and most sustained in patients aged 75 years or older, whereas death rates stabilised in this age group in the UK by 2000.
The authors say that the difference in mortality could be related to different treatment and screening policies in the two countries - for example the greater use of gonadotropin-releasing hormone treatment in older men, or more aggressive treatment of men with locally advanced and asymptomatic prostate cancer found through greater PSA testing in the USA. Another factor could be the misattribution of cause of death.
They conclude: "The decline in mortality from prostate cancer in the USA is striking in comparison to the UK, but we can only continue to speculate about the relative contributions of differences in detection and treatment, or the relative balance of benefits and harms, until the publication of findings from trials provides the robust evidence that is so eagerly awaited."
In addition, the findings from this paper give support to the views from the British Association of Urological Surgeons that many recommendations in recently released UK NICE Guidance are unfounded, inappropriate and risk worsening mortality rates in the UK from prostate cancer.
Please contact Cherry Lewis for further information.
Further information:
Kaufen generishe levitra The paper: Prostate-cancer mortality in the USA and UK in 1975-2004: an ecological study by Simon M Collin, Richard M Martin, Chris Metcalfe, David Gunnell, Peter Albertsen, David Neal, Freddie Hamdy, Peter Stephens, J Athene Lane, Rollo Moore and Jenny Donovan. Lancet Oncology, 2008; 9: 445-52.

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The US Food and Drug Administration (FDA) has received reports of sudden reduction or loss of hearing following the use of PDE5 inhibitors, a class of drugs
that includes the erectile dysfunction (ED) medications Viagra, Levitra, and Cialis and also Revatio, used to treat pulmonary arterial hypertension
(PAH).
The FDA has approved manufacturers’ label changes for the ED drugs that highlight this risk more prominently and advise consumers what to do if they
experience sudden problems with hearing.
The revised labelling for the ED drugs includes a new Precaution and updated Adverse Reactions Sections. A similar update is expected soon for the PAH drug,
Revatio. PAH is a potentially fatal condition where continuous high blood pressure in the arteries of the lungs weakens heart muscle and can lead to heart
failure and death.
In some cases the sudden loss of hearing is reported to be accompanied by tinnitus (ringing in the ears) and dizziness. The FDA said it is not possible to
establish if the hearing loss and accompanying symptoms are directly caused by the drugs because medical follow up information is limited. It is possible
the symptoms are caused by other drugs or underlying medical conditions, or even other risk factors for hearing loss, or a combination of these
things.
The number of reports of people experiencing sudden hearing loss after taking PDE5 inhibitors is said to be "very small", but there is also concern that some patients,
especially the elderly, may not realise their symptoms could be drug related, said Dr Janet Woodcock, FDA deputy commissioner for scientific and medical
programs, chief medical officer, and acting director of the FDA’s Center for Drug Evaluation and Research:
"Because some level of hearing loss is usually associated with the aging process, patients on these drugs may not think to talk to their doctor about it."
The FDA said that patients who are taking Cialis, Levitra, or Viagra and find themselves suddenly losing the ability to hear, should stop taking them
immediately and go and see their doctor. Patients taking Revatio should not stop taking it because it is treating a potentially life-threatening condition.
Instead they should continue to take the drug but seek medical attention immediately for further evaluation and advice.
The FDA said they were prompted to search its Adverse Events Reporting System for cases of hearing loss with PDE5 inhibitors after reading an
article about a man who experienced these symptoms after taking Viagra that was published in the April 2007 issue of the Journal of Laryngology &
Otology.
The agency found 29 reports of patients experiencing sudden hearing loss (mostly in one ear only) linked with PDE5 inhibitors, with and without
tinnitus, vertigo, or dizziness. In about one third of the cases the loss was temporary.
PDE5 inhibitors relax smooth muscle tissue in the blood vessels of the penis enabling their dilation and increasing blood supply to the corpus cavernosum
which leads to an erection. PDE5 is also present in the smooth muscle in the walls of arteries in the lungs, so PDE5 inhibitors are used to treat high blood
pressure caused by when these arteries become too narrow.
Click here for "Questions and Answers about Viagra, Levitra, Cialis, and
comprare il viagra senza ricetta Revatio: Possible Sudden Hearing Loss" (FDA).
Written by: Catharine Paddock
View drug information on Cialis; Levitra; Viagra.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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The U.S. Food and Drug Administration requested that SEI Pharmaceuticals, of Miami, Fla., recall all Xiadafil VIP Tabs sold in 8 tablet bottles (Lot # 6K029) or blister cards of 2 tablets (Lot # 6K029-SEI) because these products contain a potentially harmful, undeclared ingredient that may dangerously affect a person’s blood pressure and can cause other life-threatening side effects. These lots of Xiadafil VIP Tabs bear an expiration date of September 2009 (09/09). Xiadafil VIP Tabs are marketed as a dietary supplement for sexual enhancement and able to treat erectile dysfunction (ED).
Today’s formal request follows an action by the state of Florida to prevent the further distribution of this product into consumer channels. FDA is advising consumers not to buy or use this product. The agency may take further regulatory action to protect consumers from this illegal product.
Although labeled as a dietary supplement and touted as "all-natural," Xiadafil VIP Tabs are an illegally marketed drug that contains a potentially harmful undeclared ingredient. FDA chemical analysis revealed that Xiadafil VIP Tabs contains hydroxyhomosildenafil, which is an analog of sildenafil, the active ingredient in Viagra, an FDA-approved prescription drug for ED.
This undeclared ingredient may interact with nitrates found in some prescription drugs (such as nitroglycerin) and can lower blood pressure to life-threatening levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. ED is a common problem in men with these medical conditions.
"Because these products are labeled as ‘all natural dietary supplements,’ consumers may assume that they are harmless and pose no health risk," said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. "But an unsuspecting consumer with underlying medical issues may take these products without knowing that they can cause serious side effects and interact in dangerous ways with drugs that a consumer is already taking."
comprare levitra mastercard The FDA has not approved Xiadafil VIP Tabs for ED or any other drug use, and the safety and effectiveness of this product is unknown. The product is promoted and sold over the Internet, was given away as free samples at trade shows, and is sold in health food stores nationwide. The product may be packaged in bottles of eight tablets or blister cards of two tablets.
On May 13, 2008 Florida officials issued a "stop sale" action at SEI’s distribution facility in Miami, Fla. This action required the firm to hold, intact, violative Xiadafil VIP Tabs found on-hand at the facility. The state of Florida’s action to control the supply of the product, coupled with today’s formal request by FDA to recall this product from the marketplace, will further reduce the likelihood that this potentially dangerous product is used by unsuspecting consumers.
Alternative products like Xiadafil VIP Tabs are often sought out because they are marketed as "all natural" or as not containing the active ingredients in approved, prescribed ED drugs. Because the manufacturing source of the active ingredients in many of these alternative products is unknown, consumers should also be aware that the safety, efficacy, and purity of these ingredients have not been verified by the FDA.
The FDA advises consumers who have used this product to discontinue use immediately and consult their health care professional if they have experienced any adverse events that they believe may be related to the use of this product.
Consumers and health care professionals can report adverse events to the FDA’s MedWatch program at 800-FDA-1088, by mail at MedWatch, HF-2, FDA, 5600 Fishers Lane, Rockville, MD 20852-9787 or online at
Additionally, the FDA recommends that consumers talk to their health care professional about FDA-approved treatments for ED.
For more information, visit here.

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Results of the first
prospective trial specifically designed to evaluate erectile function in
erectile dysfunction (ED) patients with dyslipidemia show that LEVITRA(R)
(vardenafil HCl), used in treating ED, significantly improves the ability
of men with ED and dyslipidemia to achieve and maintain an erection for
successful sexual intercourse. These data were presented at the Sexual
Medicine Society of North America (SMSNA) Fall Meeting held in Chicago, IL.
The double-blind, placebo-controlled study is the first study to
measure the safety and efficacy of a PDE 5 inhibitor in a cohort of men who
all had ED and dyslipidemia. Results from the study of 395 men show that
LEVITRA significantly increased rates of penetration (as measured by SEP2
scores) and the ability to maintain an erection (as measured by SEP3
scores) compared to placebo.
"ED is associated with high cholesterol, yet many physicians are not
treating ED, a life-changing condition," said Dr. Martin Miner, Clinical
Associate Professor of Family Medicine at Brown University’s Warren Alpert
School of Medicine. "This study provides further support that LEVITRA can
successfully treat ED, even in men with a serious common condition like
high cholesterol."
Nearly 70 percent of the estimated 30 million men in the United States
who have ED also have other common conditions such as dyslipidemia
(including high cholesterol), hypertension, or diabetes, which may lead to
erectile dysfunction. Previous studies have demonstrated the efficacy and
safety of LEVITRA in men with ED who also have high blood pressure or
diabetes.
About the Study
In the double-blind, placebo-controlled study, 395 men ages 18 to 64
that had ED and dyslipidemia were randomized to treatment with LEVITRA or
placebo for 12 weeks.
Men treated with LEVITRA had statistically significant and clinically
relevant improvements in SEP2 scores (a rating system that measures
penetration) and SEP3 scores (a rating system that measures maintenance of
erection) versus placebo (79.1% and 66.7%, respectively, for LEVITRA, vs.
51.9% and 33.8%, respectively, for placebo). IIEF-EF (International Index
of Erectile Function) scores also were significantly higher for the LEVITRA
group compared to the placebo group. These scores are evaluated based on a
patient questionnaire and their daily diary response to specific questions
about sexual performance.
LEVITRA was well tolerated. Treatment-emergent adverse effects
(occurring in = 5% of patients) included headaches (9% for LEVITRA, 1% for
placebo) and upper respiratory tract infections (5% for LEVITRA, 3% for
placebo).
Background: Erectile dysfunction
Erectile dysfunction (ED) is the consistent or recurrent inability of a
man to attain and/or maintain a penile erection sufficient for sexual
performance. ED can be a total inability to achieve an erection, an
inconsistent ability to do so, or a tendency to sustain only brief
erections. It is estimated that some degree of ED affects up to 30 million
men in the Kaufen viagra pillen mastercard United States.
Some of the most common treatments for ED include adjustments to
lifestyle and better control of concomitant medical conditions as well as
the use of oral medications or other forms of therapy. Treating related
health conditions or reducing stress may help maintain erectile function.
About LEVITRA
LEVITRA (vardenafil HCl) is a prescription medicine that is indicated
to treat erectile dysfunction (ED). Consistent with the effects of PDE5
inhibition, administration of LEVITRA with nitrates and nitric oxide donors
is contraindicated.
Caution is advised when PDE5 inhibitors, including LEVITRA, are used
concomitantly with stable alpha-blocker therapy, because of the potential
for lowering blood pressure.
LEVITRA is not recommended for patients with uncontrolled hypertension
(>170/110 mmHg).
In men for whom sexual activity is not recommended because of their
underlying cardiovascular status, any treatment for erectile dysfunction,
including LEVITRA, generally should not be used.
In patients taking certain CYP3A4 inhibitors (eg, ritonavir, indinavir,
saquinavir, atazanavir, ketoconazole, itraconazole, erythromycin, and
clarithromycin), lower doses of LEVITRA are recommended, and time between
doses of LEVITRA may need to be extended. See prescribing information for
LEVITRA for dosing guidance.
In clinical trials, the most commonly reported adverse events with
LEVITRA were headache, flushing, and rhinitis. Adverse events were
generally transient.
Nonarteritic anterior ischemic optic neuropathy (NAION) has been
reported rarely postmarketing in temporal relationship with the use of PDE5
inhibitors, including LEVITRA. Sudden loss of hearing, sometimes with
tinnitus and dizziness, also has been reported rarely in temporal
association with the use of PDE5 inhibitors, including LEVITRA. It is not
possible to determine if these events are related to PDE5 inhibitors or to
other factors. Physicians should advise patients to stop use of PDE5
inhibitors, including LEVITRA, and seek prompt medical attention in the
event of sudden loss of vision or hearing.
The recommended starting dose of LEVITRA is 10 mg. Titrate up to 20 mg
or down to 5 mg based on efficacy and side effects.
The maximum recommended dosing frequency is once daily.
LEVITRA is available in 2.5-mg, 5-mg, 10-mg and 20-mg tablets.
For Prescribing Information please visit
About GlaxoSmithKline
GlaxoSmithKline - one of the world’s leading research-based
pharmaceutical and healthcare companies - is committed to improving the
quality of human life by enabling people to do more, feel better and live
longer. For company information, visit GlaxoSmithKline at
About Schering-Plough
Schering-Plough is an innovation-driven, science-centered global health
care company. Through its own biopharmaceutical research and collaborations
with partners, Schering-Plough creates therapies that help save and improve
lives around the world. The company applies its research-and-development
platform to human prescription and consumer products as well as to animal
health products. Schering-Plough’s vision is to "To Earn Trust, Every Day"
with the doctors, patients, customers and other stakeholders served by its
approximately 50,000 people around the world. The company is based in
Kenilworth, N.J., and its Web site is
SCHERING-PLOUGH DISCLOSURE NOTICE: The information in this press
release contains certain "forward-looking" statements within the meaning of
the Private Securities Litigation Reform Act of 1995, including statements
related to the potential market for LEVITRA. Forward-looking statements
relate to expectations or forecasts of future events. Schering-Plough does
not assume the obligation to update any forward-looking statement. Many
factors could cause actual results to differ materially from
Schering-Plough’s forward- looking statements, including market forces,
economic factors, product availability, patent and other intellectual
property protection, current and future branded, generic or
over-the-counter competition, the regulatory process, and any developments
following regulatory approval, among other uncertainties. For further
details about these and other factors that may impact the forward-looking
statements, see Schering-Plough’s Securities and Exchange Commission
filings, including Part II, Item 1A, "Risk Factors" in Schering-Plough’s
third quarter 2007 10-Q.
Schering-Plough

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