Sildenafil citrate (VIAGRA)

Poorly fitting condoms not only boost the risk of sexually transmitted diseases, they also reduce sexual pleasure during intercourse, a new study has found.

The findings are based on a survey of 436 men, aged 18 to 67, who responded to an Internet survey after being recruited through newspaper ads and a blog on a condom sales company Web site. The survey asked the men about how a condom fit the last time they used one while having sex with a female.

Nearly 45 percent said they’d used a condom that fit poorly the last time they had sex during the previous three months. These men were more than 2.5 times more likely to say their condom broke or slipped compared to those who said their condoms fit well. And they were five times more likely to say they experienced irritation to the penis.

The men whose condoms fit poorly were also about twice as likely to say that the condoms made it difficult for them, their partners or both to reach orgasm. Not surprisingly, this made intercourse less pleasurable, the study authors noted.

And the men with poor-fitting condoms were twice as likely to say they took off the condoms before they finished having sex, the survey found.

The findings “emphasize the point that men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms,” the researchers wrote.

The study, which surveyed men through the Web site of the Kinsey Institute for Research in Sex, Gender and Reproduction, is published online in February in the journal Sexually Transmitted Infections.

U.S. combat soldiers in Iraq who received a shot of morphine within an hour of being wounded were less likely to develop post-traumatic stress disorder, researchers reported on Wednesday.

The painkiller injections are no guarantee of preventing PTSD, according to the report in the New England Journal of Medicine, but the findings may help doctors find a better way to prevent the debilitating psychic strain of combat.

“We are not sure if the effect is from pain reduction or from an effect morphine has on memory consolidation in the brain immediately after a traumatic event. Or it may be both working together,” Troy Lisa Holbrook of the Naval Health Research Center in San Diego said in a telephone interview.

“We need more research to tease those out and find out which one it is,” she said.

PTSD can cause flashbacks, edginess and emotional numbness. The risk depends on the type of traumatic events a person is exposed to. A 1995 survey found that 7.8 percent of the U.S. population was destined to experience PTSD at some point.

“The search for a ‘morning-after pill’ after exposure to traumatic stress is obviously of great importance,” Dr. Matthew Friedman of the National Center for PTSD wrote in a commentary.

The study of 696 members of the Army, Navy and Marine Corps, all wounded in Iraq from 2004 to 2006, found that 61 percent of those who eventually developed PTSD had been given morphine, usually within an hour after being wounded.

But 76 percent of those who did not develop PTSD had been given morphine.

“It did not appear that the severity of the injury made any difference in this observed association,” said Holbrook, who added that many other questions needed to be explored, such as whether the dose of morphine makes a difference.

She said her team would be looking at the effects of other opiates and anti-anxiety drugs to see if they work as well, or better.

Thursday’s Journal also contains a separate study that looks at the risk of mental health problems among the wives of soldiers who are deployed in combat situations.

It found that depression, sleep disorders and anxiety were significantly more common among Army wives whose husbands had been sent to Iraq or Afghanistan. The medical records of more than a quarter of a million women were assessed.

“I don’t think these results will come as a shock. But it’s the first study of this size to put actual numbers with these issues,” Alyssa Mansfield of RTI International in North Carolina, who worked on the study, said in a telephone interview.

(Editing by Maggie Fox and Peter Cooney)

The estimated 7.5 million Americans suffering from psoriasis often have to tolerate long-term treatment that may be only moderately effective.

Now, a new drug called ustekinumab (Stelara) appears to be more effective than the old standby, etanercept (Enbrel), according to the results of a head-to-head comparison sponsored by the maker of Stelara.

“Ustekinumab is a more effective and faster acting therapy for psoriasis than the current biologic market leader for this condition,” said lead researcher Dr. Christopher E.M. Griffiths, a professor of dermatology at the University of Manchester in England.

Enbrel and Stelara are biologic agents, which work by blocking proteins produced in the body. Enbrel blocks tumor necrosis factor alpha, while Stelara inhibits interleukin-12 and interleukin-23.

This is the first head-to-head trial of two biologic therapies for psoriasis, Griffiths noted. Psoriasis is a chronic, autoimmune disease that appears on the skin.

The report is published in the Jan. 14 issue of the New England Journal of Medicine. Centocor Research and Development sponsored the study.

For the study, Griffiths and colleagues randomly assigned 903 patients with moderate-to-severe psoriasis to two different doses of Stelara injected 30 days apart or to high-dose Enbrel injections twice a week for 12 weeks.

After 12 weeks of treatment, 67.5 percent of the patients receiving 45 milligrams of Stelara had a 75 percent improvement in their condition, according to the psoriasis area-and-severity index, as did 73.8 percent of those receiving 90 milligrams of Stelara.

Only 56.8 percent of those receiving Enbrel showed a similar improvement, the researchers found.

In addition, based on doctors’ assessments, 65.1 percent and 70.6 percent of patients receiving the low and high dose of Stelara had little or no signs of psoriasis, compared with 49 percent of the patients receiving Enbrel, the team reported.

Moreover, among the patients who did not respond to Enbrel, 48.9 percent had at least a 75 percent improvement 12 weeks after switching to Stelara.

These results show that “the optimal approach to treating psoriasis may be via the targeting of the chemical messengers interleukin-12 and interleukin-23 as exemplified by ustekinumab as opposed to the chemical messenger tumor necrosis factor alpha targeted by etanercept,” Griffiths said.

Dr. Paolo Romanelli, an associate professor of dermatology at the University of Miami Miller School of Medicine, wasn’t totally surprised by the results. “These findings are exciting and a little bit expected,” he said.

Stelara was approved in October, so not many patients are receiving it yet, he noted. A main benefit of Stelara is the need for fewer injections, Romanelli said.

Romanelli advises patients receiving Enbrel to stay on the drug if they are doing well. For those who do not respond to Enbrel, there is “incredible hope to have a new medication that may help them,” he added.

Patients who don’t respond to Enbrel may respond to Stelara, the study found. The safety of the two biologics appeared similar, Griffiths said.

Common side effects included local reactions at the injection site, headache and back pain.

Before the creation of these biologics, psoriasis treatment focused on reducing inflammation with drugs such as methotrexate and cyclosporine.

Psoriasis is associated with other serious health conditions, such as diabetes, heart disease and depression, according to the National Psoriasis Foundation.

SOURCES: Christopher E.M. Griffiths, M.D., professor of dermatology, University of Manchester, England; Paolo Romanelli, M.D., associate professor of dermatology, University of Miami Miller School of Medicine, Fla.;

Men worried that taking Viagra will lead to sexually risky behavior can relax: A new study suggests that drugs for erectile dysfunction don’t make men more likely to engage in potentially unhealthy sex.

“For this study we took the perspective of a doctor who may worry that prescribing erectile-dysfunction drugs to patients could contribute to the spread of HIV. The findings from this study should provide some reassurance to health-care providers that erectile-dysfunction drugs appear to be prescribed responsibly and used responsibly,” Dr. Robert Cook, an associate professor at the University of Florida and lead researcher of the new study, said in a news release.

Cook noted that this study is unique because, unlike previous studies, it didn’t focus on men who obtained the medication without a prescription, had sex with men or had substance abuse problems.

“In this study we looked at erectile-dysfunction drugs and sexual behavior in the context of routine health care for a group of men who are more representative of the general population,” Cook said.

By the study’s definition, risky sexual behavior is unprotected sex with someone whose HIV status is opposite — positive if you’re negative or the reverse — or not known.

The researchers examined data from 2,787 men, average age 52, who were taking part in a study about aging veterans. About half were HIV-positive.

According to the study findings, 28 percent of the men used erectile-dysfunction drugs over a one-year period. About 10 percent of the men in two groups — those who did use the drugs and those who didn’t — reported behavior defined as sexually risky.

The study is published in the February issue of the Journal of General Internal Medicine.

Residents of poor neighborhoods may die sooner than residents of wealthier neighborhoods - regardless of what they eat, how active they are, or other individual risk factors, new research suggests.

This finding - that where you live might affect how long you live - comes from a study of more than 565,000 middle aged and older Americans enrolled in the NIH-AARP Diet and Health Study, which collected detailed data on diet, lifestyle, and medical history. Neighborhood characteristics were drawn from U.S. Census data for the year 2000.

“There was an increased risk of death from any cause or cancer in socioeconomically deprived neighborhoods,” Dr. Chyke Doubeni told Reuters Health. What’s noteworthy, he said, is that this difference “remained even after taking into account differences in dietary patterns and other person-level health risks.”

Doubeni, assistant professor of family medicine and community health and assistant vice provost for diversity at the University of Massachusetts Medical School in Worcester, presented his team’s findings today at the American Association for Cancer Research (AACR) Conference on Frontiers in Cancer Prevention Research underway in Houston.

“We were expecting that once we controlled for these lifestyle and medical risk factors, the differences would go away,” Doubeni noted in a conference statement. “We were surprised that the differences persisted after controlling for lifestyle factors such as smoking, diet, exercise and medical risks.”

Among the study participants, a higher percentage of adults from the most deprived neighborhoods reported poorer overall health and diet and higher average body weight. Even when these and other risk factors were taken into account, the chances of dying still rose as the level of deprivation in the place of residence increased, Doubeni and colleagues found.

Compared to people living in the least deprived neighborhoods, those living in the most deprived neighborhoods had roughly a 22 percent higher risk of dying over the 10-year study period, regardless of diet and lifestyle.

“This is a public health issue; we need to pay more attention to people who live in poor neighborhoods,” Doubeni told Reuters Health.

“We need to target public health interventions to these neighborhoods that are deprived by improving health resources and the physical environments in those areas,” Doubeni concludes.

Injections of oxytocin into the umbilical vein don’t decrease the need for manual removal in women with a retained placenta after giving birth, according to a new study.

Retained placenta occurs in 0.1 to 2 percent of deliveries, with higher rates in wealthier nations. Without prompt treatment, women with a retained placenta are at high risk of hemorrhage. Currently, treatment involves manual removal of the placenta, which requires an operating room, a surgeon and an anesthetist. But a lack of these resources means that the death rate for retained placenta is nearly 10 percent in rural communities, according to background information in the study.

An effective, cheap and simple treatment is needed. Some had thought that injecting the hormone oxytocin into the umbilical vein could fill this need, the study authors said.

This study included 577 women in Pakistan, Uganda and the United Kingdom who received 30 milliliters of saline containing either water (the placebo group) or 50 international units of oxytocin. The solution was injected into the placenta through an umbilical vein catheter.

The need for manual removal of the placenta was virtually the same for both groups: 61.3 percent for the oxytocin group and 62.1 percent for the placebo group. The researchers also found that the need for manual removal was higher in the United Kingdom (69 percent) than in Pakistan (62 percent) or Uganda (47 percent).

“These findings accord with a review in which rates of retained placenta in the U.K. are seen to be rising with time and seem to be greater in high-resource settings than in low-resource settings,” wrote Dr. Andrew D. Weeks, of the University of Liverpool and Liverpool Women’s Hospital, and colleagues.

“The reasons for this result are not clear, but it could represent the amount of exertion that is put into removal of the placenta by the attendants,” they added. “In settings in which there are long waits for [operating rooms] and in which women are tolerant of pain, there can be many attempts at placental delivery with prolonged cord traction, grasping of vaginal portions of the placenta and uterine massage. In the U.K., by contrast, operating [rooms] with regional anesthesia are easily accessible and so the woman does not need to undergo the discomfort of repeated attempts at placental delivery.”

The study authors concluded that their findings “have shown that umbilical vein oxytocin had no significant effect on the need for manual removal of the placenta or any other clinical outcome.”

Lead exposure well within levels generally considered safe may harm mental health, new research suggests.

Men and women in their 20s and 30s with the highest levels of lead in their blood were more than twice as likely to suffer from major depression as their peers with the lowest blood lead levels, while their risk of panic disorder was nearly five times greater, researchers found.

“This is true for the average American. We are not talking about excessively high exposures, it’s just average exposures,” Dr. Maryse Bouchard of University of Montreal in Canada and the Harvard School of Public Health in Boston told Reuters Health.

Lead is known to be toxic to the nervous system, Bouchard and her colleagues point out in the Archives of General Psychiatry. But most research on its effects has been done in children and in adults exposed to high levels of the toxic metal on the job.

To investigate whether lead exposure might affect the general population, Bouchard and her team looked at data from the National Health and Nutrition Examination Survey for 1999-2004 on 1,987 men and women 20 to 39 years old. About 7 percent met diagnostic criteria for major depression, while around 2 percent had panic disorder and another 2 percent had generalized anxiety disorder.

Study participants’ average blood lead level was 1.61 micrograms per deciliter of blood, and ranged from 0.3 to 37.3 micrograms per deciliter. The higher an individual’s blood lead, the greater their risk of depression or panic disorder, but lead levels had no influence on the likelihood of anxiety disorder.

Because smoking cigarettes can increase blood lead levels, Bouchard and her team did a separate analysis of non-smokers, and found similar results.

The Centers for Disease Control and Prevention has stated that blood lead levels of 10 micrograms per deciliter in children “should prompt public health actions,” but it has also stated that there is no “safe” blood level in children.

“In the general population, very little research has been done on lead and its potential adverse effects on adults,” Bouchard noted.

High levels of lead are known to interfere with the function of neurotransmitters in the brain like serotonin and dopamine, Bouchard added, and this could be the mechanism through which lead exposure might contribute to depression and panic disorder.

One drawback of the study, the researchers note in their report, is that blood lead levels are good for measuring short-term lead exposure, but less accurate for gauging long-term exposure — for this purpose, bone lead tests are more precise.

Nevertheless, they add, blood lead levels do reflect lead from past exposures being released from bone. Another limitation, they add, is the fact that depression or panic disorder might have made people engage in behaviors that would increase their blood levels of lead.

The current findings, the researchers say, suggest that efforts must be made to reduce people’s exposure to lead in the environment, for example from tap water contaminated by corroding pipes.

“The solutions are collective,” Bouchard said. “We need to enforce banning lead from all the applications that could involve potential exposure for the population.”

Diabetics who keep their blood sugar tightly controlled run the risk of having traffic accidents due to low blood sugar, Canadian researchers report.

Controlling blood sugar is the cornerstone of managing diabetes. By keeping blood sugar under control, diabetics can ward off many of the complications associated with the condition, including heart and kidney disease. However, blood sugar that is too low — known as hypoglycemia — can cause dizziness and loss of consciousness, the researchers say.

“Diabetes is a common disease that may impair an adult’s ability to drive,” said lead researcher Dr. Donald A. Redelmeier, a professor of medicine at the University of Toronto.

Worldwide, Redelmeier said, diabetics are required to produce proof of good blood-sugar control to keep their driver’s license. The United States, United Kingdom, Canada, Germany, Holland, Australia and other countries all have such laws, but they’re “based on theory rather than science,” he said.

And contrary to the prevailing theory, people with good blood-sugar control were found to have a higher risk for crashing, Redelmeier said of his study’s results. The risk was substantial, accounting for almost 50 percent of the accidents, he said.

The accidents were mostly related to severe hypoglycemia in association with strict blood sugar control, he noted. The findings were published online Dec. 8 in PLoS Medicine.

For the study, Redelmeier’s team collected data on 795 diabetic drivers. They found that one in 14 of the drivers had been involved in car accidents. Those with low blood sugar were more likely to have had an accident than were diabetics whose blood sugar was not as well controlled.

Moreover, the risk for having a car accident increased fourfold if the person had a history of hypoglycemia, the researchers found.

“This finding calls into question laws that restrict driver’s licenses on the basis of this measure of diabetes control,” Redelmeier said.

The study could be the first step in getting driving laws changed, he added. His research group, Redelmeier said, was the first to identify driving and talking on cell phones as a hazard, which led to laws restricting the use of cell phones while driving.

Dr. Luigi F. Meneghini, an associate professor of clinical medicine and director of clinical operations for the division of endocrinology, diabetes and metabolism at the University of Miami Miller School of Medicine, agreed that the study “brings up the risk of driving while you have diabetes.”

People taking medication to lower their blood sugar need to be aware of any symptoms of an oncoming hypoglycemic episode, Meneghini said. And older people, who he said often aren’t aware that a hypoglycemic episode is starting, should check their blood sugar more often.

“They should certainly check their blood sugar before they get into a car,” he said. “If they have low blood sugar, treat the low blood sugar and wait until their blood sugar is in a safe range before getting behind the wheel.”

Redelmeier said he advises diabetics not to drive if they feel dizzy or have other symptoms of hypoglycemia. In addition, he urges people to always have food available to boost the blood sugar should a hypoglycemic episode start.

Seniors enrolled in private, standalone Medicare prescription drugs plans (PDP) could encounter significant changes this open enrollment period, which begins Sunday.

Monthly premiums will rise 11 percent to $38.94, on average, according to an analysis published by the Henry J. Kaiser Family Foundation. That’s up 50 percent from 2006, the first year that Medicare Part D drug benefits were offered.

“But these changes vary considerably by plan,” added Jack Hoadley, a research professor in the Health Policy Institute at Georgetown University in Washington, D.C., and one of the report’s authors. “Just among the five most popular plans, the premium for one is up by 22 percent for 2010, while the premium for another is down by 3 percent,” he said.

So is Medicare Part D still a good buy? It all depends, experts say.

“The general advice is you do have to look beyond the premium and look at what’s covered, what your expenses are for the course of the year and whether it works for you with the drugs that you take,” said Paul Precht, director of policy and communications in the Washington, D.C., office of the Medicare Rights Center, a nonprofit consumer counseling and advocacy group.

Seniors can access Part D one of two ways. If they’re in traditional Medicare, they can select a private PDP from a wide array of options. Or, if they are enrolled in a Medicare Advantage plan, like an HMO or PPO, with prescription drug coverage, they can receive Part D benefits through that plan.

Of the nearly 27 million Medicare beneficiaries in Part D, two-thirds are enrolled in standalone PDPs, according to the Kaiser Family Foundation analysis, which examines changes in the PDP marketplace.

With dozens of PDPs from which choose in every region, sifting through the various options can be a pain. For 2010, a total of 1,576 plans will be offered nationwide — 113 fewer choices. Yet seniors will still have anywhere from 41 to 55 alternatives from which to choose in every region.

“I think it’s a good trend that the number of plans is going down. I do think there is a thing as too much choice,” said David Lipschutz, staff attorney for California Health Advocates, a nonprofit Medicare advocacy and education outfit.

Seniors will get little relief, however, from cost-sharing requirements. Sixty percent of PDPs, up from 45 percent in 2009, will require an annual deductible in 2010, for example. The maximum deductible that a plan may charge is $310.

Plan coverage of costs incurred in connection with Part D’s infamous “doughnut hole” is getting stingier, too. In 2010, many beneficiaries will have to foot the bill for the coverage gap, which begins after the enrollee has incurred $2,830 in drug spending. Coverage resumes for drug costs above $6,440.

The House of Representatives on Nov. 7 passed a sweeping health reform bill that provides gap relief beginning in 2010 and eliminates the gap by 2019. However, the Senate must act before any health reform legislation is enacted.

There are also changes in store for seniors in “benchmark” plans, which offer basic Part D coverage to individuals who qualify for a premium. Of the 7.9 million getting extra financial help, 2.2 million must switch plans or pay a portion of their premium. If they want to stay in their current plan, their share of the premium will run roughly $8 to $10 a month, Precht said.

Part D experts urge seniors to take time during the open enrollment period to consider all of their options.

“It pays to do your homework,” Lipschutz said. “The plan you’re in now could change significantly next year, not only premium-wise but also the drugs it covers, the cost-sharing it charges for the drugs, the rules it imposes on accessing those drugs, [and] the pharmacy it contracts with.”

Nicotine patches and gum seem to be safe and effective in pregnant women, according to a new study.

Such patches and gum have been shown to help non-pregnant adults stop smoking, study co-author Dr. Geeta K. Swamy told Reuters Health. However, women and their obstetricians have been uncertain about their safety and effectiveness during pregnancy.

Dr. Swamy, from Duke University Medical Center in Durham, North Carolina, and colleagues took another look at data on pregnant smokers who had participated in a study comparing psychological treatments with nicotine patches or gum to help them quit.

Adding nicotine patches or gum tripled the number of women who quit, from 8 percent to 24 percent.

Almost a third - 31 percent — of the women who used the patch or gum had pregnancy complications, compared to 17 percent of the women who did not use it.

However, there was a much higher risk of such complications in black women, those with complications in previous pregnancies, and use of painkillers. The use of the patch did not seem to have a direct effect, the researchers note.

Based on the findings, although the patch is not “absolutely safe,” it may still be worth using in heavy smokers, given the known association between smoking and bad pregnancy outcomes, particularly premature birth and low birth weight, they conclude.